吲哚菁绿荧光定位腔镜下甲状旁腺全切术对继发性甲状旁腺功能亢进患者心功能的影响

Effects of Indocyanine Green Fluorescence Localization Endoscopic Total Parathyroidectomy on Cardiac Functions in Patients With Secondary Hyperparathyroidism

目的比较吲哚菁绿(indocyanine green,ICG)荧光定位腔镜下甲状旁腺全切术与开放甲状旁腺全切术对慢性肾功能衰竭继发甲状旁腺功能亢进(hyperparathyroidism,HPT)患者术后心功能影响的差异。方法2019年4月~2020年6月我院25例慢性肾功能衰竭继发性HPT接受ICG荧光定位腔镜下甲状旁腺全切术作为腔镜组,24例慢性肾功能衰竭继发性HPT接受开放甲状旁腺全切术作为开放组,比较2组患者手术前后血钙、血磷、甲状旁腺素(parathyroid hormone,PTH)、血红蛋白、N末端B型钠尿肽前体(N-terminal pro-B-type natriuretic peptide,NT-pro-BNP),以及心脏超声重要参数。结果术后3个月2组比较PTH、血钙、血磷差异有显著性(P<0.05),血红蛋白差异无显著性(P>0.05)。与术前比较,腔镜组术后3个月血磷、PTH、血红蛋白、血钙均明显改善(P<0.05),开放组血磷、PTH、血红蛋白明显改善(均P=0.000)。与术前比较,术后3个月2组NT-pro-BNP均显著下降(P<0.05),腔镜组下降更为显著。术后3个月2组比较左心室舒张末内径(left ventricular end diastolic diameter,LVEdD)、左心室收缩末内径(left ventricular end systolic diameter,LVEsD)、射血分数(ejection fraction,EF)、左心室短轴收缩率(fraction shortening,FS)差异均有显著性(P<0.05)。腔镜组术前与术后3个月LVEdD、LVEsD、EF、左心室FS差异均有显著性(P<0.05);开放组术前与术后3个月LVEdD、EF、左心室FS差异有显著性(P<0.05),LVEsD差异无显著性(P>0.05)。结论甲状旁腺全切术能显著改善继发性HPT患者心功能及心脏内径、收缩功能变化,且ICG荧光定位腔镜下手术较常规开放手术获益更大。

Objective To compare the effect of endoscopic total parathyroidectomy with indolyanine green(ICG)fluorescence localization and routine parathyroidectomy on cardiac function in patients with secondary hyperparathyroidism.Methods From April 2019 to June 2020,25 patients with secondary hyperparathyroidism who received endoscopic total parathyroidectomy with ICG fluorescence localization(endoscopic group)and 24 patients who received conventional total parathyroidectomy(open group)were enrolled.The serum calcium,phosphorus,parathyroid hormone(PTH),hemoglobin,N-terminal pro-B-type natriuretic peptide(NT-pro-BNP)levels and cardiac ultrasound parameters were compared before and after operation and between the two groups.Results At 3 months after operation,there were significant differences in PTH,serum calcium,and serum phosphorus(P<0.05),but no significant differences in hemoglobin(P>0.05)between the two groups.As compared to preoperation,the PTH,serum phosphorus,hemoglobin,and serum calcium were significantly improved in the endoscopic group(P<0.05),and serum phosphorus,PTH and hemoglobin were significantly improved in the open group(all P=0.000).As compared to preoperation,the level of NT-pro-BNP decreased significantly 3 months after operation in both groups(P<0.05),and the decrease level was more significant in the endoscopic group.There were significant differences in left ventricular end diastolic diameter(LVEdD),left ventricular end systolic diameter(LVEsD),ejection fraction(EF),and fraction shortening(FS)3 months after operation between the two groups(P<0.05).There were significant differences in cardiac ultrasound indexes,such as LVEdD,LVEsD,EF,FS,in the endoscopic group before operation and 3 months after operation(P<0.05).There was significant difference in LVEdD,EF,and FS between preoperative and 3 months after operation in the open group(P<0.05),but there was no significant difference in LVEsD(P>0.05).Conclusions Total parathyroidectomy with ICG fluorescence localization significantly improves cardiac function,cardiac diameter,and systolic function in patients with secondary hyperparathyroidism.Endoscopic surgery is more beneficial than conventional surgery.