Clinical application of parathyroid autofluorescence imaging in endoscopic thyroid surgery
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摘要: 目的 探讨近红外线自体荧光显影技术在腔镜甲状腺手术中识别保护甲状旁腺的应用价值。方法 选取2022年5月—2023年2月在桂林市人民医院甲状腺乳腺血管外科接受腔镜甲状腺手术患者158例，应用内镜荧光摄像系统在腔镜甲状腺术中全程监测自体荧光显影的甲状旁腺共214枚，其中对术中不能原位保留需做自体移植或解剖不能明确为甲状旁腺组织的前15例患者钳取部分送快速冷冻病理，确定是否为甲状旁腺。结果 术中不能原位保留需做自体移植或解剖不能明确为甲状旁腺组织的前15例患者中，自体荧光显影甲状旁腺为23枚，病理确诊甲状腺旁腺21枚，2枚为脂肪组织，准确率为91.30%；158例患者术后2 h血钙较术前下降(P＜0.05)，术后5 d血钙较术前下降(P＜0.01)，术后5 d血钙较术后2 h稍回升，但差异无统计学意义(P＞0.05)；同时比较甲状旁腺激素(PTH)，术后2 h PTH较术前PTH下降明显(P＜0.01)，术后5 d PTH较术前下降(P＜0.01)，但较术后2 h PTH升高(P=0.001)。结论 腔镜甲状腺手术中，应用近红外线自体荧光显影技术可帮助外科医生快速识别、保护甲状旁腺，降低永久性甲状旁腺功能减退的发生率。结合自体荧光显影、腔镜放大下的视觉解剖识别、术中冷冻病理检查“三位一体”的方法，可提高甲状旁腺识别的成功率。
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关键词:
- 甲状旁腺 /
- 腔镜甲状腺手术 /
- 近红外线自体荧光显影
Abstract: Objective To investigate the application value of near-infrared autofluorescence imaging in identifying and protecting parathyroid glands in endoscopic thyroid surgery.Methods 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.Results 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(P < 0.05), decreased blood calcium 5 days after operation compared with preoperative blood calcium(P < 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(P > 0.05); while comparing parathyroid hormone(PTH), PTH at 2 hours after operation decreased significantly compared with PTH before operation(P < 0.01), and PTH at 5 days after operation compared with PTH before operation PTH also decreased(P < 0.01), but increased compared with PTH 2 hours after operation(P=0.001).Conclusion 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. -
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表 1 不同手术方式的手术前后血钙与PTH的比较
手术方式 数量 甲状旁腺数目/枚 血钙/mmol/L PTH/pg/mL 术前 术后2 h 术后5 d 术前 术后2 h 术后5 d 单侧腺叶切除术 67 104 2.23~2.58 2.01~3.41 2.03~2.41 25.3~66.50 13.22~63.30 14.60~70.17 单侧腺叶切除+对侧次全切除术 28 47 2.10~2.58 2.02~2.87 2.32~2.90 33.40~56.90 7.55~52.11 25.34~45.70 双侧腺叶次全切除术 17 9 2.17~2.56 2.11~2.58 2.14~2.67 28.30~54.70 25.40~50.70 34.60~45.30 单侧腺叶次全切除术 12 4 2.15~2.76 2.24~2.39 2.29~2.33 36.70~52.90 33.45~53.40 37.90~44.67 单侧腺叶近全切除术 7 4 2.15~2.41 2.02~2.34 2.26~2.38 30.30~38.80 20.56~35.60 25.19~43.20 双侧腺叶切除术 13 37 2.19~2.43 1.91~2.37 2.00~2.27 34.10~54.60 5.52~43.14 10.34~44.68 单侧近全切除术+ 对侧次全切除术 5 5 2.21~2.32 2.13~2.21 2.11~2.23 32.40~45.70 16.73~50.12 26.85~51.40 单侧腺叶切除+对侧部分切除术 9 4 2.24~2.48 2.05~2.54 2.03~2.47 33.60~65.70 23.71~55.55 32.23~72.91 
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