甲状腺手术中荧光显像技术保护甲状旁腺的应用进展  

Application progress of fluorescence imaging technology for parathyroid protection in thyroid surgery

作　　者：迟昊 李昆临 杨明宇 隋成秋 王宏博 白珂成 蓝东媛 张大奇[1] CHI Hao;LI Kunlin;YANG Mingyu;SUI Chengqiu;WANG Hongbo;BAI Kecheng;LAN Dongyuan;ZHANG Daqi(Department of Thyroid Surgery,China-Japan Union Hospital of Jilin University/Jilin Provincial Key Laboratory of Surgical Translational Medicine/Jilin Provincial Engineering Laboratory of Thyroid Disease Prevention and Control,Changchun 130033,China)

机构地区：[1]吉林大学中日联谊医院甲状腺外科/吉林省外科转化医学重点实验室/吉林省甲状腺疾病防治工程实验室,吉林长春130033

出　　处：《中国普通外科杂志》2023年第11期1778-1786,共9页China Journal of General Surgery

基　　金：国家科技部外专局“一带一路”创新人才交流外国专家基金资助项目(DL2023129007L);吉林省卫生科研人才专项基金资助项目(2022SCZ22)。

摘　　要：在甲状腺手术中,甲状旁腺能否得到有效的保护将对患者的预后产生较大的影响。目前术中对甲状旁腺的保护方法多为肉眼识别,术者根据术中观察到的甲状旁腺的形态及血供情况,决定是否对其进行自体移植。然而,由于甲状旁腺在术中与周围脂肪及淋巴组织在形态和颜色上较为接近,这对肉眼的识别效果产生了很大的影响。因此,在甲状腺手术中急需一种帮助术者快速有效识别甲状旁腺的方法。近年来,荧光显像技术在甲状腺外科领域的应用成为研究热点,应用该技术在术中对甲状旁腺及其血供进行显像,为术中甲状旁腺的保护提供了一种新的方法。荧光显像技术可分为自体荧光显像(NIRAF)和外源性荧光显像两种方式,不同的荧光显像方式其所涉及的原理、运用的设备及术中实时显像的效果各不相同。目前NIRAF多用于术中对甲状旁腺的识别,该技术可以提高术者对甲状旁腺的识别率,但其显像效果受多种因素的影响,如患者的血钙浓度、甲状旁腺的位置及其周围组织情况等。外源性荧光显像依赖于荧光显像剂的应用,荧光显像剂主要包括吲哚菁绿(ICG)、低剂量亚甲蓝(MB)和5-氨基乙酰丙酸(5-ALA)。目前应用最广泛的荧光显像剂是ICG,当其与血中脂蛋白特异性结合后,在近红外光照射下可以对甲状旁腺及其周围血供进行显像,有助于术者对甲状旁腺进行识别,并判断其周围血供情况。随着甲状腺更多术式的不断开展,ICG近年来也逐渐在腔镜、达芬奇机器人手术中得以应用。这种方法的局限性在于其对甲状旁腺进行识别的结果存在着假阳性和假阴性的可能,且术者在对甲状旁腺周围的血供情况进行判断时,易受自身主观因素的影响。其他外源性荧光显像方法,如低剂量的MB和5-ALA的使用,尽管同样可以对甲状旁腺进行荧光显像,但因有文献报道其可引起多种不良反应,In thyroid surgery,the effective protection of the parathyroid glands can have a significant impact on the prognosis of patients.Currently,intraoperative protection of the parathyroid glands is mostly based on visual identification.Surgeons decide whether to perform autotransplantation based on the observed morphology and blood supply of the parathyroid glands during surgery.However,the close resemblance of the parathyroid glands to surrounding fat and lymphatic tissues in morphology and color significantly affects the efficacy of visual identification.Therefore,there is an urgent need for a method to assist surgeons in rapidly and effectively identifying the parathyroid glands during thyroid surgery.In recent years,the application of fluorescence imaging technology in thyroid surgery has become a research hotspot.This technology is used to visualize the parathyroid glands and their blood supply during surgery,providing a new method for intraoperative protection of the parathyroid glands.Fluorescence imaging technology can be divided into near-infrared autofluorescence imaging(NIRAF)and exogenous fluorescence.The principles,equipment used,and real-time imaging effects vary between different fluorescence imaging methods.At present,NIRAF is mostly used for intraoperative identification of parathyroid glands,improving the surgeon's identification rate.However,its imaging effectiveness is influenced by various factors such as the patient's blood calcium concentration,the location of the parathyroid glands,and the surrounding tissue conditions.Exogenous fluorescence imaging relies on the application of fluorescence imaging agents,including indocyanine green(ICG),low-dose methylene blue(MB),and 5-aminolevulinic acid(5-ALA).The most widely used fluorescence imaging agent is ICG,which,when specifically bound to blood lipoproteins,can be visualized under near-infrared light,aiding the surgeon in identifying the parathyroid glands and assessing the surrounding blood supply.In recent years,ICG has gradually been applied in

关 键 词：甲状腺切除术 光学成象 甲状旁腺 综述 

分 类 号：R653.2[医药卫生—外科学]