一种新的术中甲状旁腺识别方法:甲状旁腺自体荧光显像(附6例报告)

目的 在甲状腺手术中通过甲状旁腺自体荧光显像技术识别和保护甲状旁腺。 方法 选取2020年6月在甲状腺乳腺外科接受甲状腺手术患者6例,术前甲状旁腺素及血清钙、磷检测均在正常范围。3例结节性甲状腺肿患者中1例行甲状腺腺叶切除术,2例行甲状腺全切除术;3例甲状腺乳头状癌患者行甲状腺全切术,其中2例同时行中央区淋巴结清扫,1例同时行中央区+单侧颈侧区清扫术。应用荧光手术导航系统在术中分别于显露甲状腺后、甲状旁腺显露后以及甲状腺切除后、中央区淋巴结清扫完成后等时间点进行甲状旁腺自体荧光显像。 结果 6例患者的22枚甲状旁腺在显露前均未检测到自体荧光,经外科医师解剖显露后均可探测到明显的自体荧光,自体荧光显像率100%,甲状腺、淋巴结和脂肪组织都没有显示出实质性的自发荧光。1枚甲状旁腺离体后仍显示自体荧光。 结论 甲状旁腺在近红外光谱中呈现自体荧光特征。这一效应在甲状腺切除术中可用于确认甲状旁腺,但不能作为寻找甲状旁腺的导航工具。

A new method to identify parathyroid glands in surgery: parathyroid autofluorescence imaging(a report of 6 cases)

Objective To introduce a new method to identify and protect the parathyroid glands in thyroid surgery with autofluorescence imaging. Methods A total of 6 patients who underwent thyroid surgery at our department in June 2020 were enrolled. The preoperative parathyroid hormone, serum calcium and phosphorus measurements were within the normal range. For the 3 patients with nodular goiter, 1 received thyroid lobectomy, and 2 received total thyroidectomy. Three patients with papillary thyroid carcinoma underwent total thyroidectomy, 2 of whom received simultaneous central lymph nodes dissection, and 1 received simultaneous lymph nodes dissection of central area + unilateral neck. Fluorescence surgical navigation system was used to perform autofluorescence imaging of parathyroid glands at the following time points: after the thyroid glands were exposed, after the parathyroid glands were exposed, after thyroidectomy, and after the completion of central lymph node dissection. Results Twenty-two parathyroid glands in 6 patients were not detected with autofluorescence before being exposed, but could be detected with obvious autofluorescence after being exposed. The autofluorescence imaging rate was 100%. The thyroids, lymph nodes and adipose tissues did not show substantial autofluorescence. One parathyroid gland still showed autofluorescence after being isolated. Conclusion Parathyroid glands show autofluorescence characteristics in the near-infrared spectrum. This can help to identify the parathyroid glands during thyroidectomy, but cannot be used as a navigation tool for parathyroid recognition.