Takahashi Takeshi, Sa Shalyn J D, Oya Ryohei, Ohshima Shusuke, Omata Jo, Yokoyama Yusuke, Shodo Ryusuke, Ueki Yushi, Takenaka Yukinori, Inohara Hidenori, Horii Arata
Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
University of Leicester, Leicester, United Kingdom.
PLoS One. 2025 Apr 24;20(4):e0321310. doi: 10.1371/journal.pone.0321310. eCollection 2025.
To evaluate the role of parathyroid near-infrared autofluorescence in reducing the incidence of postoperative hypocalcemia and hypoparathyroidism after total thyroidectomy, and to determine which surgeons benefit most from parathyroid near-infrared autofluorescence use.
A literature search was conducted in PubMed, Web of Science, and the Cochrane Library databases for English-language articles published from June 2011 to October 31, 2023. The inclusion criteria were studies conducted on patients who underwent total thyroidectomy for benign or malignant thyroid pathologies, comparing postoperative parathyroid function between parathyroid near-infrared autofluorescence techniques and conventional surgery with data on calcium and/or parathyroid hormone levels. The exclusion criteria included: reviews, letters, meta-analyses, case reports, animal experiments, or basic research. Of the initial 387 articles retrieved, we included 14. A meta-analysis was performed to calculate the pooled odds ratio and weighted mean deviation with a random-effects model. Main outcomes were Calcium and parathyroid hormone levels after total thyroidectomy with or without parathyroid near-infrared autofluorescence use.
Fourteen studies were included in the meta-analysis. Pooled odds ratios of temporary and permanent hypocalcemia were 0.56 (95% confidence interval 0.43-0.72) and 0.61 (95% confidence interval 0.33-1.13), respectively. Meta-regression analysis revealed that near-infrared autofluorescence benefits surgeons with the high incidence of temporary hypocalcemia by naked eye surgery (≥15%) by reducing temporary hypocalcemia (p = 0.0091) and skillful surgeons by increasing the number of autotransplanted parathyroid glands (p = 0.0225).
Parathyroid near-infrared autofluorescence has different benefits depending on the skill level of the surgeon.
评估甲状旁腺近红外自发荧光在降低全甲状腺切除术后低钙血症和甲状旁腺功能减退发生率方面的作用，并确定哪些外科医生从使用甲状旁腺近红外自发荧光中获益最大。
在PubMed、Web of Science和Cochrane图书馆数据库中检索2011年6月至2023年10月31日发表的英文文章。纳入标准为对因良性或恶性甲状腺疾病接受全甲状腺切除术的患者进行的研究，比较甲状旁腺近红外自发荧光技术与传统手术术后甲状旁腺功能，并提供钙和/或甲状旁腺激素水平数据。排除标准包括：综述、信函、荟萃分析、病例报告、动物实验或基础研究。在最初检索到的387篇文章中，我们纳入了14篇。采用随机效应模型进行荟萃分析，计算合并比值比和加权平均偏差。主要结局是使用或不使用甲状旁腺近红外自发荧光进行全甲状腺切除术后的钙和甲状旁腺激素水平。
14项研究纳入荟萃分析。暂时性和永久性低钙血症的合并比值比分别为0.56（95%置信区间0.43 - 0.72）和0.61（95%置信区间0.33 - 1.13）。荟萃回归分析显示，近红外自发荧光通过降低暂时性低钙血症（p = 0.0091）使肉眼手术时暂时性低钙血症发生率高（≥15%）的外科医生获益，通过增加自体移植甲状旁腺数量使技术熟练的外科医生获益（p = 0.0225）。
甲状旁腺近红外自发荧光根据外科医生的技术水平有不同的益处。
