经口腔前庭入路机器人甲状腺切除术中使用吲哚菁绿荧光显影技术的安全性与效果分析

Safety and efficacy analysis of using indocyanine green fluorescence imaging technique in transoral robotic thyroidectomy vestibular approach

背景与目的:目前,机器人甲状腺手术中采用吲哚菁绿(ICG)荧光显影技术识别与保护甲状旁腺的相关报道相对较少,因此,其临床实用性仍需进一步研究。本研究通过比较在经口腔前庭入路机器人甲状腺切除术(TORTVA)使用与不使用ICG荧光显影技术病例资料的对比分析,探讨TORTVA术中应用ICG荧光显影技术的安全性与有效性。方法:回顾性收集2018年12月—2021年11月行TORTVA患者的病历资料,经筛选后纳入80例患者,其中45例术中采用ICG荧光显影技术(ICG组),35例未使用ICG荧光显影技术(对照组),采用1∶1最邻近匹配法进行倾向性评分匹配(PSM)消除两组间混淆偏差后,比较两组患者术中、术后相关指标。结果:PSM后,两组各纳入24例患者,两组间基线资料均衡可比。ICG组与对照组的术中出血量差异无统计学意义(P=0.910),但ICG组的平均手术时间明显短于对照组(223 min vs.251 min,P=0.032)。两组术中淋巴结清扫数目、阳性淋巴结数目及淋巴结阳性率差异均无统计学意义(均P>0.05)。两组患者总住院时间与术后住院时间差异无统计学意义(均P>0.05)。两组间术后甲状旁腺素与血清钙水平差异均无统计学意义(均P>0.05)。ICG组3例(12.5%)、对照组6例(25.0%)出现并发症,两组间并发症发生率的差异无统计学意义(P=0.461);两组均无术中甲状旁腺自体移植患者,均无永久性喉返神经损伤和甲状旁腺功能减退发生。结论:TORTVA术中利用ICG荧光显影技术不会增加术后并发症的风险,具有可靠的安全性;TORTVA术中利用ICG荧光显影技术可以更清楚地显示甲状旁腺,显著缩短手术时间,具有一定的有效性。

Background and Aims:Currently,there is limited literature on the use of indocyanine green(ICG)fluorescence imaging technique for identification and protection of the parathyroid glands in robotic thyroid surgery,and further research is needed to explore its clinical utility.This study was performed to explore the safety and effectiveness of employing ICG fluorescence imaging technique during transoral robotic thyroidectomy vestibular approach(TORTVA)by comparing cases with and without its use.Methods:Data of patients who underwent TORTVA between December 2018 and November 2021 were retrospectively collected.After screening,80 patients were included.Among them,45 patients underwent surgery with the use of ICG fluorescence imaging technique(ICG group),while 35 patients did not use this technique(control group).Propensity score matching(PSM)was performed using a 1∶1 nearest-neighbor matching method to eliminate confounding bias between the two groups.Then,the intraoperative and postoperative parameters were compared between the two groups of patients.Results:After PSM,24 patients were included in each group,with balanced baseline characteristics.There was no statistically significant difference in intraoperative blood loss between the ICG group and the control group(P=0.910).However,the ICG group demonstrated a significantly shorter average operative time compared to the control group(223 min vs.251 min,P=0.032).There were no statistically significant differences in the number of lymph nodes dissected,positive lymph nodes,and lymph node positivity rate between the two groups(all P>0.05).Total hospital stay and postoperative hospital stay showed no statistically significant differences between the two groups(both P>0.05).There were no significant differences in postoperative parathyroid hormone and serum calcium levels between the two groups(all P>0.05).The incidence of complications was 12.5%in the ICG group and 25.0%in the control group,with no statistically significant difference(P=0.461).Both groups had no patients undergoing intraoperative autotransplantation of the parathyroid glands,and there were no occurrences of permanent recurrent laryngeal nerve injury or hypoparathyroidism in the either group.Conclusion:The use of ICG fluorescence imaging technology during TORTVA does not increase the risk of postoperative complications,demonstrating reliable safety.Additionally,it provides clearer visualization of the parathyroid glands,significantly reducing operative time and exhibiting certain effectiveness.