Preoperative ultrasonography parathyroid gland mapping can improve identification of normal parathyroid gland during thyroidectomy: A propensity score-matched case-control study.

IF 2.3 3区 医学 Q1 OTORHINOLARYNGOLOGY
Kwang Hyun Yoon, Jong Cheol Lee, Yong Jin Song, Won Jun Kim, Myoung Sook Shim, Ha Young Kim, Jin Yub Kim, Byeong-Joo Noh, Dong Gyu Na
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引用次数: 0

Abstract

Background: Accurate intraoperative identification of normal parathyroid glands (PTGs) is vital to avoid hypocalcemia post total thyroidectomy. Although ultrasonography (US) has been shown to identify normal PTGs, the significance of preoperative US PTG mapping in this context is not well studied. This study evaluated the impact of preoperative US PTG mapping on intraoperative identification of normal PTGs during total thyroidectomy.

Methods: The study involved 161 consecutive patients who underwent total thyroidectomy between January 2020 and June 2022. These included patients without preoperative US PTG mapping (group 1, n = 91) and those with the mapping (group 2, n = 70). Propensity score matching yielded 61 matched patients from each group. We developed a preoperative US PTG mapping technique combining US identification of normal PTGs with their localization on thyroid CT images. The intraoperative detectability of normal PTGs during thyroid surgery and detectability of normal PTGs by the preoperative US mapping were assessed by the number of PTGs identified per patient and by location.

Results: In the matched cohort, group 2 demonstrated a higher median number of identified PTGs (3 vs. 2, p = 0.011), a greater proportion of patients with three or more identified PTGs (65.5% vs. 44.3%, p = 0.018), and a higher ratio of identified to expected PTGs (70.5% vs. 60.2%, p = 0.011) than group 1. In group 2, the median number of normal PTGs identified preoperatively was 3, with at least one identified in 95.7% of patients, two or more in 84.3%, three or more in 52.9%, and four or five in 24.3%.

Conclusions: Preoperative US PTG mapping identified two or more normal PTGs in the majority of adult patients undergoing total thyroidectomy. Those with preoperative mapping showed a higher number of intraoperatively identified normal PTGs, including inferior PTGs, compared to those without. This technique appears to enhance the intraoperative identification of normal PTGs, thereby potentially improving surgical outcomes in total thyroidectomy.

术前超声甲状旁腺造影可提高甲状腺切除术中正常甲状旁腺的识别率:倾向评分匹配病例对照研究
背景:术中准确识别正常的甲状旁腺(PTG)对于避免甲状腺全切除术后出现低钙血症至关重要。虽然超声波(US)已被证明能识别正常的甲状旁腺,但术前 US PTG 图谱在这方面的意义还没有得到很好的研究。本研究评估了在甲状腺全切除术中,术前 US PTG 图谱对术中识别正常 PTG 的影响:这项研究涉及 161 名在 2020 年 1 月至 2022 年 6 月期间接受甲状腺全切除术的连续患者。其中包括术前未进行 US PTG 图谱绘制的患者(第 1 组,n = 91)和进行了图谱绘制的患者(第 2 组,n = 70)。通过倾向评分匹配,两组各有 61 名匹配患者。我们开发了一种术前 US PTG 映射技术,将 US 鉴定正常 PTG 与甲状腺 CT 图像定位相结合。术中甲状腺手术中正常PTG的可探测性和术前US绘图正常PTG的可探测性通过每位患者被识别的PTG数量和位置进行评估:在配对队列中,第2组显示出更高的已识别PTG中位数(3 vs. 2,p = 0.011)、更高比例的患者有3个或更多已识别PTG(65.5% vs. 44.3%,p = 0.018)以及更高的已识别PTG与预期PTG比率(70.在第 2 组中,术前确定的正常 PTG 中位数为 3 个,95.7% 的患者至少确定了一个,84.3% 的患者确定了两个或更多,52.9% 的患者确定了三个或更多,24.3% 的患者确定了四个或五个:大多数接受全甲状腺切除术的成年患者术前通过美国PTG图谱检查发现了两个或两个以上正常的PTG。与未绘制PTG图的患者相比,术前绘制PTG图的患者术中发现的正常PTG(包括下PTG)数量更多。这项技术似乎能提高术中识别正常PTG的能力,从而改善全甲状腺切除术的手术效果。
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来源期刊
CiteScore
7.00
自引率
6.90%
发文量
278
审稿时长
1.6 months
期刊介绍: Head & Neck is an international multidisciplinary publication of original contributions concerning the diagnosis and management of diseases of the head and neck. This area involves the overlapping interests and expertise of several surgical and medical specialties, including general surgery, neurosurgery, otolaryngology, plastic surgery, oral surgery, dermatology, ophthalmology, pathology, radiotherapy, medical oncology, and the corresponding basic sciences.
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