近红外自体荧光成像对术中甲状旁腺实时识别的初步研究

A preliminary study on real-time identification of parathyroid gland by near-infrared autofluorescence imaging

目的评估近红外自体荧光成像(near-infrared autofluorescence imaging,NIRAF)技术对甲状旁腺(parathyroid gland,PG)进行术中实时识别的临床效果.方法2020年6~8月我院甲状腺外科行甲状腺手术的病人59例,分别通过肉眼及NIRAF对PG进行术中识别,并对识别结果不一致的可疑PG组织进行术中免疫胶体金检测.结果59例甲状腺手术病人,共切除79叶甲状腺,术中实际最终确认PG 144枚,忽略较少见的PG数目变异,按常规辨认PG 158枚计算,总体检出率为91.1%(144/158),PG总体移植率为4.4%(7/158).NIRAF与肉眼的PG检出率分别为90.5%(143/158)、86.7%(137/158),准确率分别为98.6%(143/145)、100%(137/137),两组比较差异无统计学意义.但在甲状腺被膜解剖前,肉眼PG检出率为31.6%(50/158),NIRAF增加到55.7%(88/158),差异有统计学意义(P<0.05).结论在甲状腺被膜解剖前,术中采用NIRAF成像,可增加PG的识别率,有很好的预判性;此外,NIRAF成像对手术全程肉眼识别和定位PG、及必要时离体组织中寻找PG是一个有益的补充,直观、实时、无创、无需造影剂.

Objective To evaluate the effect of real-time recognition of parathyroid gland(PG)intraoperatively by near-infrared autofluorescence imaging(NIRAF).Methods The clinical data of 59 patients undergoing thyroid surgery from June 2020 to August 2020 were analyzed.PG was identified by naked eyes and NIRAF imaging respectively during operation.The suspected PG tissues with inconsistent identification results were tested by intraoperative immunocolloidal gold to verify.Results A total of 79 thyroids were excised in 59 patients and 158 PGs were expected to be identified routinely ignoring uncommon number variation.However,only 144 PGs were finally confirmed,and the detection rate was 91.1%(144/158).In addition,the transplantation rate of PG was 4.4%(7/158).The detection rate of NIRAF imaging and naked eyes was 90.5%(143/158)and 86.7%(137/158)respectively,and the accuracy rate was 98.6%(143/145)and 100%(137/137)respectively,with no significant difference between them.It is worth mentioning that,the detection rate of NIRAF was 55.7%(88/158),significantly higher than naked eyes(31.6%,50/158)before the thyroid capsule anatomy(P<0.05).Conclusion The usage of intraoperative NIRAF imaging could significantly increase the recognition rate of PG before thyroid capsule anatomy with good predictability.Moreover,NIRAF imaging can perform intraoperative PG identification,locate PG before and after dissection,and find PG in vitro tissues.It has the advantages of intuitive,real-time,non-invasive,and no contrast agent,etc.,which can be a useful supplement for naked eyes.