近红外成像检测和自体甲状旁腺移植对全喉全甲状腺切除术的影响

IF 1.6 4区医学 Q2 OTORHINOLARYNGOLOGY

Auris Nasus Larynx Pub Date : 2025-04-09 DOI:10.1016/j.anl.2025.03.004

Takeshi Takahashi , Kohei Otaki , Shusuke Ohshima , Yuto Takahashi , Ryoko Tanaka , Kohei Saijo , Jo Omata , Yusuke Yokoyama , Ryusuke Shodo , Yushi Ueki , Keisuke Yamazaki , Hiroshi Matsuyama , Arata Horii

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引用次数: 0

摘要

目的甲状腺全切除术（TT）后持续性甲状旁腺功能减退症（hypoPT）是一种严重的并发症，需要终生治疗。当合并全喉切除术（TL）时，HypoPT会更严重，因为并不总是尝试原位保存或自体移植甲状旁腺（pg）。本研究检验了近红外荧光成像（NIFI）识别PG的准确性，并评估了TL+TT患者PG自身移植的肿瘤学安全性和对hypoPT的影响。该前瞻性研究于2020年6月至2023年11月在日本新泻的三家医院进行。纳入12例接受TL+TT治疗的患者。标本在体外用NIFI评估自身荧光（AF），然后进行组织学检查。术后监测白蛋白校正钙水平和完整甲状旁腺激素（PTH）水平。结果29例af阳性组织经NIFI鉴定为可能的pg。组织学检查显示27例为pg， 2例为脂肪组织：每例患者自体移植pg 0-5例（中位数=2）。外科医生目视检查分离的272个淋巴结组织均为AF阴性，组织学检查均未发现pg。因此，NIFI对PG鉴定具有100%的敏感性和99%的特异性。术后持续hypoopt率为33%（4/12）。中位随访42个月（16-54个月），自体甲状旁腺移植部位未见肿瘤复发。结论NIFI在TL+TT中鉴定pg具有较高的准确性。在NIFI辅助下，PG自身移植成为缓解TL+TT手术术后hypoopt的可行技术。

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The impact of detecting and autotransplanting parathyroid gland with near-infrared imaging during total laryngectomy with total thyroidectomy

Objective

Persistent postoperative hypoparathyroidism (hypoPT) after total thyroidectomy (TT) is a serious complication necessitating lifelong treatment. HypoPT would be more serious when combined with total laryngectomy (TL), since in situ preservation nor autotransplantation of parathyroid glands (PGs) is not always attempted. This study examined the accuracy of identifying PGs using near-infrared fluorescence imaging (NIFI) and assessed the oncological safety and impact of PG autotransplantation on hypoPT in TL+TT.

Methods

This prospective study was conducted between June 2020 and November 2023 at three hospitals in Niigata, Japan. Twelve patients who underwent TL+TT were included. Specimens were evaluated for autofluorescence (AF) using NIFI ex vivo followed by histological examination. Levels of albumin-corrected calcium and intact parathyroid hormone (PTH) were monitored postoperatively.

Results

Twenty-nine AF-positive tissues were identified as possible PGs using NIFI. Histological examination revealed that 27 were PGs and 2 were adipose tissues: 0–5 (median=2) PGs were autotransplanted per patient. All 272 tissues isolated as lymph nodes by the surgeon's visual inspection were negative for AF, none of which were PGs by histological examinations. Therefore, NIFI exhibited 100 % sensitivity and 99 % specificity for PG identification. The rate of persistent postoperative hypoPT was 33 % (4/12). After a median follow-up of 42 months (range 16–54 months), no tumor recurrence was observed in the sites of parathyroid autotransplantation.

Conclusion

This study demonstrated the high accuracy of NIFI in identifying PGs during TL+TT. PG autotransplantation with NIFI assistance emerged as a viable technique for mitigating postoperative hypoPT in TL+TT procedures.

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来源期刊

Auris Nasus Larynx 医学-耳鼻喉科学

CiteScore

3.40

自引率

5.90%

发文量

169

审稿时长

30 days

期刊介绍： The international journal Auris Nasus Larynx provides the opportunity for rapid, carefully reviewed publications concerning the fundamental and clinical aspects of otorhinolaryngology and related fields. This includes otology, neurotology, bronchoesophagology, laryngology, rhinology, allergology, head and neck medicine and oncologic surgery, maxillofacial and plastic surgery, audiology, speech science. Original papers, short communications and original case reports can be submitted. Reviews on recent developments are invited regularly and Letters to the Editor commenting on papers or any aspect of Auris Nasus Larynx are welcomed. Founded in 1973 and previously published by the Society for Promotion of International Otorhinolaryngology, the journal is now the official English-language journal of the Oto-Rhino-Laryngological Society of Japan, Inc. The aim of its new international Editorial Board is to make Auris Nasus Larynx an international forum for high quality research and clinical sciences.