Hypoparathyroidism is the most frequent complication in thyroid surgery. The aim of this study was to evaluate the impact of intraoperative parathyroid gland identification, using autofluorescence imaging, on the rate of post-operative (PO) hypoparathyroidism in thyroid cancer surgery. Patients undergoing total thyroidectomy with central neck dissection from 2018 to 2022 were included. A prospective cohort of 77 patients operated on using near-infrared autofluorescence (NIRAF+) with the Fluobeam®(Fluoptics, Grenoble, France) system was compared to a retrospective cohort of 94 patients (NIR−). The main outcomes were the rate of PO hypocalcemia, with three cutoffs: corrected calcium (Cac) < 2.10 mmol/L, <2.00 mmol/L and <1.875 mmol/L, and the rate of permanent hypoparathyroidism, at 12 months. The rate of PO Cac < 2.10 mmol/L was statistically lower in the NIRAF+ group, compared to the control group (36% and 60%,p= 0.003, respectively). No statistically significant difference was observed for the other two thresholds. There was a lower rate of permanent hypoparathyroidism in the NIRAF+ group (5% vs. 14% in the control group), although not statistically significant (p= 0.07). NIRAF is a surgically non-invasive adjunct, and can improve patients’ outcomes for thyroid cancer surgery by reducing post-operative temporary hypoparathyroidism. Larger prospective studies are warranted to validate our findings.
甲状旁腺功能减退是甲状腺手术中最常见的并发症。本研究旨在评估甲状腺癌手术中应用自体荧光成像技术进行术中甲状旁腺识别对术后甲状旁腺功能减退发生率的影响。研究纳入2018年至2022年间接受甲状腺全切及中央区颈清扫术的患者。将使用Fluobeam®（法国格勒诺布尔Fluoptics公司）近红外自体荧光系统进行手术的77例前瞻性队列患者（NIRAF+组）与94例回顾性队列患者（NIR-组）进行比较。主要观察指标包括术后低钙血症发生率（采用三个截断值：校正血钙<2.10 mmol/L、<2.00 mmol/L和<1.875 mmol/L）以及12个月时永久性甲状旁腺功能减退发生率。结果显示，NIRAF+组术后校正血钙<2.10 mmol/L的发生率显著低于对照组（分别为36%和60%，p=0.003），而其他两个截断值指标未见统计学差异。NIRAF+组永久性甲状旁腺功能减退发生率呈现降低趋势（5% vs. 对照组14%），但未达到统计学显著性（p=0.07）。研究表明，近红外自体荧光成像作为非侵入性手术辅助技术，可通过降低术后暂时性甲状旁腺功能减退发生率改善甲状腺癌手术患者的预后，但需更大规模的前瞻性研究验证该结论。
肿瘤(癌症)患者之家