探针式近红外自体荧光探测技术在甲状腺全部切除术中对甲状旁腺的识别与保护效果的临床研究

Clinical Study on the Effect of Probe-Type Near-Infrared Autofluorescence Detection Technology in the Identification and Protection of Parathyroid Glands During Total Thyroidectomy

摘要: 目的：探讨探针式近红外自体荧光探测技术用于双侧甲状腺全部切除手术中甲状旁腺识别及功能保护的有效性。方法：收集2024年6月至2024年12月安徽医科大学第一附属医院因甲状腺乳头状癌行双侧甲状腺全部切除 + 双侧中央区淋巴结清扫患者的临床资料共144例。术中使用探针式近红外自体荧光探测仪识别甲状旁腺的75例患者设为自体荧光组，使用负显影剂识别甲状旁腺的69例患者设为负显影组。分析比较两组患者术中甲状旁腺识别率、原位保留率、术后PTH水平、术后血钙水平以及术后甲状旁腺功能减退率。结果：自体荧光组术中共识别出甲状旁腺284枚，其中疑似甲状旁腺组织18枚(识别率93.67%)，负显影组术中共识别出甲状旁腺247枚，其中疑似甲状旁腺38枚(识别率84.62%)，差异具有统计学意义(P = 0.001 < 0.05)；自体荧光组术中甲状旁腺原位保留率高于负显影组(P = 0.001 < 0.05)；自体荧光组术后低钙血症发生21例(发生率28%)，负显影组发生31例(发生率44.93%)，两组差异具有统计学意义(P = 0.035 < 0.05)；自体荧光组术后暂时性甲状旁腺功能减退发生29例(发生率38.67%)负显影组发生39例(发生率56.52%)，两组差异具有统计学意义(P = 0.032 < 0.05)，两组均未发生永久性甲状旁腺功能减退。两组患者在肿瘤侵犯脉管、术后血钙水平及术后PTH水平上的差异具有统计学意义(P < 0.05)。结论：探针式近红外自体荧光探测技术可作为甲状腺切除术中甲状旁腺识别与功能保护的有效手段。

Abstract: Objective: To explore the effectiveness of probe-based near-infrared autofluorescence detection technology in the identification and functional protection of parathyroid glands during total bilateral thyroidectomy. Methods: A total of 144 cases of clinical data were collected from patients who underwent total bilateral thyroidectomy with bilateral central lymph node dissection due to thyroid cancer at the First Affiliated Hospital of Anhui Medical University from June 2024 to December 2024. Among them, 75 patients who used a probe-type near-infrared autofluorescence detector to identify parathyroid glands during surgery were assigned to the autofluorescence group, and 69 patients who used the negative contrast agent to identify parathyroid glands were assigned to the negative imaging group. The intraoperative parathyroid gland identification rate, in-situ preservation rate, postoperative PTH level, postoperative blood calcium level, and postoperative hypoparathyroidism rate were analyzed and compared between the two groups of patients. Results: In the auto-fluorescence group, a total of 284 parathyroid glands were identified, including 18 suspected parathyroid tissues (identification rate 93.67%). In the negative imaging group, 247 parathyroid glands were identified, including 38 suspected parathyroid tissues (identification rate 84.62%). The difference was statistically significant (P = 0.001 < 0.05). The in situ retention rate of parathyroid glands in the auto-fluorescence group was higher than that in the negative imaging group (P = 0.001 < 0.05). Postoperatively, 21 cases (28%) of hypocalcemia occurred in the auto-fluorescence group, compared to 31 cases (44.93%) in the negative imaging group, with a statistically significant difference (P = 0.035 < 0.05). Transient hypoparathyroidism occurred in 26 cases 38.67%) in the auto-fluorescence group and 39 cases (56.52%) in the negative imaging group, with a statistically significant difference (P = 0.032 < 0.05). No permanent hypoparathyroidism was observed in either group. Differences in tumor invasion of blood vessels, postoperative serum calcium levels, and postoperative PTH levels were statistically significant between the two groups (P < 0.05). Conclusion: Probing-based near-infrared auto-fluorescence detection technology can serve as an effective method for parathyroid identification and functional protection during thyroidectomy.