| Objective:Hypopathyroidism(HPP)is one of the common complications of thyroid surgery,especially in patients with thyroid cancer undergoing central lymph node dissection.Accurate identification of parathyroid gland during operation is the key to prevent this complication.This study was designed to investigate the feasibility of intraoperative near infrared fluorescence imaging(NIRI)to identify misexcised parathyroid glands in central lymph node specimens during radical thyroid cancer resection and whether this technique can reduce the incidence of postoperative hypoparathyroidism.Methods:A prospective analysis was made of 60 thyroid cancer patients in the Department of Breast Cancer Surgery,Provincial Hospital Affiliated to Anhui Medical University from May 2020 to January 2021,who required central lymph node dissection and who were unable to identify the lower extreme parathyroid gland due to subjective experience.The dissected central lymph node samples were randomly divided into two groups according to whether NIRI test was performed or not and the odd-even number of admission number: In the "traditional group" without NIRI test and the "NIRI group" with NIRI test,both the traditional group and the NIRI group underwent surgery according to the standard procedure of radical thyroid carcinoma requiring central lymph node dissection.During the operation of the NIRI group,the excised central lymph node specimens were scanned by NIRI technique to determine whether the parathyroid autofluorescence was shown.A small part of NIRI tissue containing autofluorescence of parathyroid gland was excised and made into frozen sections for verification.At the end of the operation,the mistakenly excised parathyroid gland was implanted into the sternocleidomastoid muscle.In the traditional group,no NIRI technique was used to examine the parathyroid gland,and postoperative routine pathology was used to determine whether the parathyroid gland was mistakenly excised during the operation.The number of cases of autologous parathyroid transplantation during operation,the number of cases of parathyroid gland being excised by mistake,the number of cases of central lymph node excision,the number of cases of hypoparathyroidism after operation and the blood calcium concentration one week after operation were compared and analyzed between the two groups.Results SPSS19.0software was used for analysis,and P < 0.05 was considered statistically significant.Result:Among the 60 patients,12 were male and 48 were female.The mean age was44.38±10.61 years old and the median age was 46 years old.Unilateral thyroidectomy included 19 patients and bilateral thyroidectomy included 41 patients.The preoperative average calcium concentration was 2.26±0.89mmol/L.Postoperative pathology was papillary thyroid carcinoma,and the clinical characteristics of the two groups were not statistically significant.In the traditional group,an average of 3.60±2.91 lymph nodes in the central region were removed intraoperatively,and 8 patients showed numbness of hands and feet after the operation.One week after the operation: There were 7 patients with Ca+ < 2.00mmol/ L,while in the NIRI group,the average number of central lymph nodes removed during the operation was 6.37±4.87.There were 2 patients with numbness of hands and feet after the operation,and 1 patient with Ca+ < 2.00mmol/ L showed statistical significance.In the NIRI group,21 patients were found to have parathyroid autofluorescence in the resected central lymph node specimens,and 20 of them were confirmed to be parathyroid tissue by frozen sections,and parathyroid autotransplantation was performed.However,in the traditional group,6 patients were confirmed to have parathyroid glands in the specimens by postoperative routine pathology.Conclusions:Intraoperative near-infrared imaging technology can assist surgeons in non-invasive,accurate and timely detection of accidentally excised parathyroid glands during surgery,and can reduce the incidence of postoperative hypoparathyroidism. |
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