Moreno Llorente Pablo, Alberich Prats Marta, García Barrasa Arantxa, Pascua Solé Mireia, Muñoz de Nova José Luis
Endocrine Surgery Unit, Department of Surgery, Hospital Universitari de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain; Institut d'Investigació Biomèdica de Bellvitge (IDIBELL) (HUB-IDIBELL), Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
Endocrine Surgery Unit, Department of Surgery, Hospital Universitari de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.
Surgery. 2025 May;181:109142. doi: 10.1016/j.surg.2024.109142. Epub 2025 Jan 29.
This study aimed to compare the rates of postoperative and permanent hypocalcemia between postthyroidectomy indocyanine green angiography and indocyanine green angiography-guided thyroidectomy performed intraoperatively for identification and preservation of the parathyroids.
We undertook a retrospective study of 2 cohorts of patients with thyroid cancer undergoing total thyroidectomy and central neck dissection. The first cohort (control group) included patients who underwent postthyroidectomy indocyanine green angiography to predict parathyroid function by scoring the degree of fluorescence (0, black; nonvascularized; 1, gray/heterogeneous: partially vascularized; and 2, white: well vascularized), and the second cohort (angiography-guided thyroidectomy) included patients undergoing initially indocyanine green angiography-guided thyroidectomy to identify the feeding vessels of the parathyroid glands followed by postthyroidectomy indocyanine green angiography.
There were 54 patients (97 sides) in the control group and 43 (71 sides) in the angiography-guided thyroidectomy group. The superior glands were significantly better preserved (indocyanine green score of 2) in the angiography-guided thyroidectomy group as compared with the control group (53.7% vs 34.5%, P = .026). The final parathyroids with an indocyanine green ICG score of 2 was greater in the angiography-guided thyroidectomy group than in the control group (47.8% vs 26.6%, P = .016). Postoperative hypocalcemia was significantly more common in the control group than in the angiography-guided thyroidectomy group (31.5% vs 7.0%, P = .007) as well as permanent hypocalcemia (11.1% vs 0%, P = .032).
Indocyanine green angiography-guided thyroidectomy allowing identification of the vascular supply of the parathyroid glands contributes to preserve functioning glands and to prevent postsurgical hypocalcemia.
本研究旨在比较甲状腺切除术后吲哚菁绿血管造影与术中吲哚菁绿血管造影引导下甲状腺切除术用于识别和保留甲状旁腺时术后及永久性低钙血症的发生率。
我们对两组接受甲状腺全切除术和中央区淋巴结清扫术的甲状腺癌患者进行了一项回顾性研究。第一组（对照组）包括接受甲状腺切除术后吲哚菁绿血管造影以通过对荧光程度评分（0，黑色；无血管化；1，灰色/不均匀：部分血管化；2，白色：血管化良好）来预测甲状旁腺功能的患者，第二组（血管造影引导下甲状腺切除术组）包括最初接受吲哚菁绿血管造影引导下甲状腺切除术以识别甲状旁腺供血血管然后进行甲状腺切除术后吲哚菁绿血管造影的患者。
对照组有54例患者（97侧），血管造影引导下甲状腺切除术组有43例患者（71侧）。与对照组相比，血管造影引导下甲状腺切除术组的上级甲状旁腺保存情况明显更好（吲哚菁绿评分为2）（53.7%对34.5%，P = 0.026）。血管造影引导下甲状腺切除术组最终吲哚菁绿（ICG）评分为2的甲状旁腺比对照组更多（47.8%对26.6%，P = 0.016）。对照组术后低钙血症明显比血管造影引导下甲状腺切除术组更常见（31.5%对7.0%，P = 0.007），永久性低钙血症也是如此（11.1%对0%，P = 0.032）。
吲哚菁绿血管造影引导下甲状腺切除术能够识别甲状旁腺的血管供应，有助于保留功能正常的腺体并预防术后低钙血症。
