Pace-Asciak P, Russell J, Solorzano C, Berber E, Singer M, Shaha A R, Khafif A, Angelos P, Nixon I, Tufano R P
Department of Otolaryngology-Head and Neck Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA.
Head Neck. 2023 Dec;45(12):3157-3167. doi: 10.1002/hed.27538. Epub 2023 Oct 8.
Thyroid and parathyroid surgery requires careful dissection around the vascular pedicle of the parathyroid glands to avoid excessive manipulation of the tissues. If the blood supply to the parathyroid glands is disrupted, or the glands are inadvertently removed, temporary and/or permanent hypocalcemia can occur, requiring post-operative exogenous calcium and vitamin D analogues to maintain stable levels. This can have a significant impact on the quality of life of patients, particularly if it results in permanent hypocalcemia. For over a decade, parathyroid tissue has been noted to have unique intrinsic properties known as "fluorophores," which fluoresce when excited by an external light source. As a result, parathyroid autofluorescence has emerged as an intra-operative technique to help with identification of parathyroid glands and to supplement direct visualization during thyroidectomy and parathyroidectomy. Due to the growing body of literature surrounding Near Infrared Autofluorescence (NIRAF), we sought to review the value of using autofluorescence technology for parathyroid detection during thyroid and parathyroid surgery. A literature review of parathyroid autofluorescence was performed using PubMED. Based on the reviewed literature and expert surgeons' opinions who have used this technology, recommendations were made. We discuss the current available technologies (image vs. probe approach) as well as their limitations. We also capture the opinions and recommendations of international high-volume endocrine surgeons and whether this technology is of value as an intraoperative adjunct. The utility and value of this technology seems promising and needs to be further defined in different scenarios involving surgeon experience and different patient populations and conditions.
甲状腺和甲状旁腺手术需要在甲状旁腺血管蒂周围进行仔细的解剖，以避免对组织进行过度操作。如果甲状旁腺的血液供应受到干扰，或者甲状旁腺被意外切除，可能会发生暂时性和/或永久性低钙血症，这就需要术后补充外源性钙和维生素D类似物以维持稳定的水平。这可能会对患者的生活质量产生重大影响，尤其是当导致永久性低钙血症时。十多年来，人们已经注意到甲状旁腺组织具有独特的内在特性，即“荧光团”，当受到外部光源激发时会发出荧光。因此，甲状旁腺自体荧光已成为一种术中技术，有助于识别甲状旁腺，并在甲状腺切除术和甲状旁腺切除术中辅助直接可视化。由于围绕近红外自体荧光（NIRAF）的文献越来越多，我们试图回顾在甲状腺和甲状旁腺手术中使用自体荧光技术检测甲状旁腺的价值。我们使用PubMed对甲状旁腺自体荧光进行了文献综述。基于综述的文献和使用该技术的专家外科医生的意见，我们提出了建议。我们讨论了当前可用的技术（图像法与探头法）及其局限性。我们还收集了国际上大量从事内分泌外科手术的医生的意见和建议，以及这项技术作为术中辅助手段是否有价值。这项技术的实用性和价值似乎很有前景，需要在涉及外科医生经验以及不同患者群体和病情的不同场景中进一步明确。
