吲哚菁绿荧光显影在经口腔前庭入路机器人甲状腺手术中对甲状旁腺保护的初步研究

Preliminary study of indocyanine green fluorescence imaging in the protection of parathyroid glands under transoral robotic thyroidectomy vestibular approach

目的:探讨吲哚菁绿荧光显影在经口腔前庭入路机器人甲状腺手术中对甲状旁腺保护的可行性。方法:18例患者行经口腔前庭入路机器人甲状腺手术,女性17例,男性1例,平均年龄(45.78±11.64)岁,平均肿瘤直径(0.97±0.50)cm,术中静脉推注吲哚菁绿识别甲状旁腺及其血供。对患者术前及术后血清甲状旁腺素(Parathyroid hormone,PTH)和血清钙离子浓度水平、术中清扫淋巴结数目及并发症情况等进行分析。结果:18例患者均实施甲状腺癌根治术,术中均可见荧光显影的甲状旁腺,平均清扫淋巴结数目(8.67±6.41)枚,术后病理结果均提示甲状腺乳头状癌,并有部分淋巴结转移。术后2例患者出现一过性甲状旁腺功能低下,无1例患者出现永久性甲状旁腺功能低下及由此引起的低钙血症,术后无患者出现暂时性或永久性喉返神经(Recurrent laryngeal nerve,RLN)损伤。所有患者术后恢复良好,无其他并发症。结论:在机器人荧光显影模式下,通过静脉注射吲哚菁绿荧光显影技术避免甲状旁腺意外损伤是安全、可行的,由于本研究纳入患者例数较少,仍需进一步行临床试验证实其安全性和有效性。

Objective:To investigate the feasibility of indocyanine green fluorescence imaging in protecting parathyroid glands under transoral robotic thyroidectomy vestibular approach.Methods:18 patients(1 male and 17 females)underwent robotic thyroidectomy were given intravenous bolus of indocyanine green to identify parathyroid glands and their blood supply.The average age of 18 patients was(45.78±11.64)years,with an average tumor size of(0.97±0.50)cm.The serum parathyroid hormone(PTH),serum ionized calcium levels,number of resected lymph nodes,and other complications before and after surgery were recorded and analyzed.Results:18 patients were given radical thyroidectomy for thyroid cancer,and parathyroid glands were all visible under indocyanine green fluorescence imaging during surgeries.The number of dissected lymph nodes were(8.67±6.41).The postoperative pathological results all suggested papillary thyroid cancer with part of lymph node metastasis.There were 2 cases of transient hypoparathyroidism,and no permanent hypoparathyroidism or hypocalcemia occurred.No temporary or permanent recurrent laryngeal nerve(RLN)injury due to accidental parathyroid injury was found.All patients recovered well after surgery with no other complications.Conclusion:It is feasible and safety perform transoral robotic thyroidectomy vestibular approach with indocyanine green fluorescence imaging,which could avoid accidental parathyroid glands injury.Due to the limited number of patients in this study,further clinical trials shall be performed to confirm its safety and effectiveness.