术中甲状旁腺光学定位与活性判断在甲状腺和甲状旁腺外科的应用前景  

Application prospect of intraoperative optical localization and activity determination of parathyroid gland in thyroid and parathyroid surgery

作　　者：张颖超 伍波[1] 樊友本[1] Zhang Yingchao;Wu Bo;Fan Youben(Department of General Surgery,Thyroid and Parathyroid Center,Shanghai Jiao Tong University Affiliated Sixth People’s Hospital,Shanghai 200233,China)

机构地区：[1]上海交通大学附属第六人民医院普外科,上海交通大学甲状腺疾病诊治中心,200233

出　　处：《中华内分泌外科杂志》2020年第5期432-435,共4页Chinese Journal of Endocrine Surgery

基　　金：国家自然科学基金(81670718);中国科学院大学宁波生命与健康产业研究院合作项目(2019yjy0201)。

摘　　要：甲状腺手术特别是甲状腺全切加中央区淋巴结清扫的主要风险之一是甲状旁腺误切和(或)血运受损,可致暂时性或永久性甲状旁腺功能减退,引起低钙血症,目前已成为困扰甲状腺手术医生和患者的难题之一。原发性或肾性甲状旁腺功能亢进需切除病变旁腺,而术中快速寻找或辨认旁腺有时较困难,特别是存在异位或额外旁腺时。目前对甲状旁腺的寻找辨认和保护主要依靠外科医师的经验,传统术中快速冰冻、纳米炭负显影和甲状旁腺激素(parathyroid hormone,PTH)试纸等辅助辨认方法仍有一定局限性。近红外自体荧光成像和光学相干断层成像可直观准确的进行术中甲状旁腺实时定位显示,吲哚菁绿荧光成像和激光散斑对比成像对术中甲状旁腺活性判断也有一定价值。本文就这些光学技术的应用原理、初步临床研究和应用前景进行综述。One of the major risks of total thyroidectomy,especially with central cervical lymph node dissection,is unintentional resection and devascularization of the parathyroid gland(PG),which leads to temporary or permanent hypoparathyroidism(hypoPT)and causes hypocalcemia.Nowadays postoperative hypoPT is one of the most troubling complications for both surgeons and patients all around the world.In addition,primary or renal hypoPT requires the removal of pathological PG(s).However,rapid identification of PGs,particularly ectopic or excess PG,could be sometimes difficult.Currently,the identification and protection of PGs mainly depend on the experience of surgeons and auxiliary methods such as fast frozen pathology,the negative imaging through nano-carbon,or PTH test strip,still have some limitations.As initial researches show,near-infrared autofluorescence imaging and optical coherence tomography can accurately perform the real-time identification of PGs;indocyanine green fluorescence or laser speckle contrast imaging can help to judge the activity of PGs intraoperatively.The basic principle,clinical application and prospect of these optical techniques in thyroid and parathyroid surgery will be reviewed in our article.

关 键 词：甲状腺 甲状旁腺 术中旁腺定位和活性判断 光学技术 近红外自体荧光成像 吲哚菁绿荧光成像 

分 类 号：R653[医药卫生—外科学] R736.1[医药卫生—临床医学]