Tao Weijie, Duan Ran, Gao Ying, Wang Jinmiao, Wang Shoujun, Hao Jie, Gao Ming
Department of Thyroid and Breast Surgery, Tianjin Union Medical Center, The First Affiliated Hospital of Nankai University, Tianjin, China.
Gland Surg. 2025 Aug 31;14(8):1519-1528. doi: 10.21037/gs-2025-118. Epub 2025 Aug 26.
The hypocalcemia and hypoparathyroidism due to parathyroid damage during thyroid cancer surgery seriously affect the quality of life of patients. Although contemporary scholars have implemented different technologies, demonstrating improved intraoperative outcomes, there is still a lack of reliable real-time recognition technology. The aim of this study is to assess the efficacy of near-infrared autofluorescence (NIRAF) imaging combined with immunocolloidal gold technique (ICGT) in identifying and protecting parathyroid glands (PTGs) during thyroid cancer surgery.
This retrospective cohort study evaluated 62 thyroid cancer patients undergoing total thyroidectomy with bilateral central lymph node dissection (CLND) by the same surgical team (January-December 2023). Cohort allocation was based on intraoperative identification methods: the observation group (n=34) received NIRAF and ICGT, while the control group (n=28) underwent standard visual assessment. Primary endpoints included (I) intraoperative parathyroid detection quantitation; (II) rates of gland preservation autotransplantation; and (III) incidence of unintended parathyroid resection. Secondary outcomes assessed postoperative biochemical profiles [parathyroid hormone (PTH) and calcium levels at 24/72 h] and surgical complications. All statistical comparisons were performed with SPSS version 27.0.
Intraoperative analysis demonstrated superior glandular preservation in the NIRAF-ICGT cohort, with 128/132 (97.0%) PTGs maintained versus 83/97 (85.6%) in conventional controls (P<0.001). Transplantations differed significantly between groups (4 14 cases, P=0.009). Although accidental resection rates showed non-significant disparity (1 5 glands, P>0.05), immediate postoperative metrics revealed substantial physiological advantages. Biochemical monitoring at 24 h postoperatively showed higher calcium levels in the observation group (2.11±0.13 1.94±0.10 mmol/L, P<0.001), paralleled by elevated PTH values {16.88 [interquartile range (IQR) 4.97] 10.50 [3.70] pg/mL, P<0.001}. These differentials persisted through postoperative day 3: calcium concentrations (2.17±0.77 2.08±0.11 mmol/L, P<0.001) and PTH levels [25.38 (IQR 3.38) 14.32 (IQR 2.08) pg/mL, P<0.001]. Clinically, the observation group exhibited reduced hypocalcemia incidence (12 18 cases) and lower transient hypoparathyroidism rates (10 16 case), both P<0.05.
Compared to traditional visual recognition, the NIRAF-ICGT integrated technology can help surgeons better identify and protect parathyroid function during thyroid cancer surgery.
甲状腺癌手术期间因甲状旁腺损伤导致的低钙血症和甲状旁腺功能减退严重影响患者生活质量。尽管当代学者已采用不同技术，术中结果有所改善，但仍缺乏可靠的实时识别技术。本研究旨在评估近红外自发荧光（NIRAF）成像联合免疫胶体金技术（ICGT）在甲状腺癌手术中识别和保护甲状旁腺（PTG）的疗效。
本回顾性队列研究评估了由同一手术团队进行全甲状腺切除术并双侧中央淋巴结清扫术（CLND）的62例甲状腺癌患者（2023年1月至12月）。队列分配基于术中识别方法：观察组（n = 34）接受NIRAF和ICGT，而对照组（n = 28）进行标准视觉评估。主要终点包括：（I）术中甲状旁腺检测定量；（II）腺体保留和自体移植率；（III）意外甲状旁腺切除发生率。次要结局评估术后生化指标[术后24/72小时甲状旁腺激素（PTH）和钙水平]及手术并发症。所有统计比较均使用SPSS 27.0版进行。
术中分析显示，NIRAF - ICGT队列的腺体保留情况更佳，132个PTG中有128个（97.0%）得以保留，而传统对照组为97个中的83个（85.6%）（P < 0.001）。两组间移植情况差异显著（4对14例，P = 0.009）。尽管意外切除率差异无统计学意义（1对5个腺体，P > 0.05），但术后即时指标显示出明显的生理优势。术后24小时生化监测显示观察组钙水平更高（2.11±0.13对1.94±0.10 mmol/L，P < 0.001），同时PTH值升高{16.88[四分位数间距（IQR）4.97]对10.50[3.70] pg/mL，P < 0.001}。这些差异持续至术后第3天：钙浓度（2.17±0.77对2.08±0.11 mmol/L，P < 0.001）和PTH水平[25.38（IQR 3.38）对14.32（IQR 2.08）pg/mL，P < 0.001]。临床上，观察组低钙血症发生率降低（12对18例），短暂性甲状旁腺功能减退率更低（10对16例），两者P均< 0.05。
与传统视觉识别相比，NIRAF - ICGT综合技术可帮助外科医生在甲状腺癌手术中更好地识别和保护甲状旁腺功能。
