Sun Jun, Guo Linzheng, Kang Jiaming, Tao Yanping, Wang Jianyun
Department of Thyroid Breast Vascular Surgery，Guilin People's Hospital，Guilin，541002，China.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2023 Oct;37(10):832-836. doi: 10.13201/j.issn.2096-7993.2023.10.014.
To investigate the application value of near-infrared autofluorescence imaging in identifying and protecting parathyroid glands in endoscopic thyroid surgery. From May 2022 to February 2023, 158 patients who underwent endoscopic thyroid surgery in the Department of Thyroid and Breast Vascular Surgery of Guilin People's Hospital were selected. The endoscopic fluorescence camera system was used to monitor the parathyroid glands under autofluorescence during endoscopic thyroid surgery. A total of 214 pieces were collected, among which the first 15 cases that could not be preserved in situ during the operation needed to be autotransplanted or the tissue clamped parts that could not be clearly identified as parathyroid glands were sent to fast-frozen pathology to determine whether they were parathyroid glands. Among the first 15 patients who could not be preserved in situ during the operation or whose anatomy could not be clearly defined, 23 parathyroid glands were detected by autofluorescence imaging, 21 parathyroid glands were confirmed by pathology, and 2 were adipose tissue, with an accuracy rate of 91.30%; 158 patients underwent surgery Blood calcium decreased 2 hours after operation compared with preoperative blood calcium（<0.05）, decreased blood calcium 5 days after operation compared with preoperative blood calcium（<0.01）, and increased slightly 5 days after the operation compared to blood calcium 2 hours after the operation, but the difference was not statistically significant>0.05）; while comparing parathyroid hormone（PTH）, PTH at 2 hours after operation decreased significantly compared with PTH before operation（<0.01）, and PTH at 5 days after operation compared with PTH before operation PTH also decreased（<0.01）, but increased compared with PTH 2 hours after operation（=0.001）. In laparoscopic thyroid surgery, the application of near-infrared autofluorescence imaging technology can help surgeons quickly identify and protect parathyroid glands, and reduce the incidence of permanent hypoparathyroidism. Combining autofluorescence imaging, visual anatomy recognition under magnification of laparoscope, and intraoperative frozen pathological examination "trinity" method can improve the success rate of parathyroid gland recognition.
探讨近红外自发荧光成像在腔镜甲状腺手术中识别和保护甲状旁腺的应用价值。选取2022年5月至2023年2月在桂林市人民医院甲状腺乳腺血管外科行腔镜甲状腺手术的158例患者，术中应用内镜荧光摄像系统监测甲状旁腺自发荧光情况。共采集214枚，其中术中无法原位保留的前15例需行自体移植或无法明确辨认的组织钳夹部分送快速冰冻病理确定是否为甲状旁腺。在术中无法原位保留或解剖结构无法明确的前15例患者中，自发荧光成像检出甲状旁腺23枚，病理确诊甲状旁腺21枚，脂肪组织2枚，准确率为91.30%；158例患者术后2小时血钙较术前血钙下降（<0.05），术后5天血钙较术前血钙下降（<0.01），术后5天血钙较术后2小时血钙略有升高，但差异无统计学意义（>0.05）；而比较甲状旁腺激素（PTH），术后2小时PTH较术前PTH明显下降（<0.01），术后5天PTH较术前PTH也下降（<0.01），但较术后2小时PTH升高（=0.001）。在腔镜甲状腺手术中，应用近红外自发荧光成像技术可帮助术者快速识别和保护甲状旁腺，降低永久性甲状旁腺功能减退症的发生率。联合自发荧光成像、腔镜放大下视觉解剖辨认及术中冰冻病理检查“三位一体”方法可提高甲状旁腺辨认成功率。
