The initial exploration of near-infrared fluorescence-guided total parathyroidectomy in patients with secondary hyperparathyroidism using indocyanine green
10.3760/cma.j.issn.1674-6090.2019.04.007
- VernacularTitle:吲哚菁绿在继发性甲状旁腺功能亢进甲状旁腺全切术中近红外荧光导航的初步探究
- Author:
Le CUI
1
;
Yan ZHANG
Author Information
1. 武汉大学人民医院乳腺甲状腺外科 430070
- Keywords:
Secondary hyperparathyroidism;
Total parathyroidectomy;
Indocyanine green;
Intraoperative fluorescence-guided
- From:
Chinese Journal of Endocrine Surgery
2019;13(4):293-296
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore the method and application value of near-infrared fluorescence-guided total parathyroidectomy (TPTX) in patients with secondary hyperparathroidism (SHPT) using indocyanine green (ICG).Methods The clinical data of 38 patients with SHPT undergoing fluorescence-guided TPTX from Dec.2013 to Jun.2017 were collected.All patients were treated with intravenous injection of ICG 30 minutes before operation.Near-infrared fluorescence imaging of parathyroid glands during surgery was observed and all parathyroid glands were resected.The preoperative and postoperative levels of parathyroid hormone,serum calcium and serum phosphorus were recorded to assess total resection and surgical efficacy.The complications such as hemorrhage and wound infection were observed.Results The fluorescence-guided TPTX was successful in all patients.The operation time was 75 to 225 mins.A total of 149 parathyroid glands were localized by fluorescence imaging,including 11 escaped glands by preoperative imaging examination.However,another 7 fluorescence-labeled tissue was inflammatory lymph node or fibrous adipose tissue.Intraoperative fluorescence-guided technique could identify the location and number of parathyroid glands.The level of parathyroid hormone before operation and 30 minutes after resection was (1797.3±838.8) pg/ml and (187.2±109.2) pg/ml,respectively,and maintained low level after operation.The differences were statistically significant(F=155.001,P=0.000).Compared with the level before surgery,the postoperative level of serum calcium and serum phosphorus decreased to normal range with significant differences (F=41.842,P=0.000;F=49.491,P=0.000).No perioperative death happened.One patient sufferred neck hematoma due to heparin,and one patient developed hypertension.No complications such as wound infection and pulmonary infection occurred to any patient.Conclusions Intraoperative fluorescence-guided TPTX using ICG in the patient with SHPT is safet and feasible,and is expected to be a novel technique for intraoperative dynamic examination and real-time localization of parathyroid gland.
