甲状旁腺自荧光显影技术应用研究

doi:10.6040/j.issn.1673-3770.1.2020.025

摘要/Abstract

摘要： 甲状旁腺损伤引起的暂时性和永久性功能减退目前仍不可避免。近年发现甲状旁腺含特有的荧光物质,机制未明。目前在甲状旁腺实时定位中可以使用两种自体荧光探查设备(Fluobeam影像系统、PTeye纤维探针接触式系统),用于甲状旁腺的术中定位和保护。在切除标本中挽救性检出甲状旁腺是该技术的优势,甲状旁腺和甲状腺自体荧光强度比值分别是1.23~7.71。甲状腺术中自体荧光甲状旁腺探查比例76.3%~98.0%,在甲状旁腺术中探查准确性达到90.5%~99.0%。甲状旁腺的自体荧光技术非侵入性,优点是准确实时费时少,不使用染料作对比剂。

关键词: 甲状旁腺, 旁腺保护, 自体荧光, 应用进展, 综述

Abstract: The temporary and permanent dysfunction caused by parathyroid injury are inevitable. The parathyroid contains a special fluorescent substance, although its mechanism is not clear. At present, two kinds of autofluorescence detection equipment(FLUOBEAM ® imaging system, PTeye fiber probe contact system)can be used for real-time localization of the parathyroid gland for intraoperative localization and protection. The major advantage of this technique is that is allows detection of the parathyroid in excised specimens. The ratios of autofluorescence intensities of the parathyroid and thyroid are 1.23 and 7.71, respectively. The proportion of autofluorescence parathyroid identification sensitivity was 76.3-98.0% and the accuracy was 90.5-99.0%. The parathyroid gland autofluorescence technique is non-invasive, less time-consuming, provides accurate real-time information, and does not use dye as a contrast agent.

Key words: Parathyroid glands, parathyroid protection, autofluorescence, progress, review

中图分类号:

R739.91

宋西成,郑海涛. 甲状旁腺自荧光显影技术应用研究[J]. 山东大学耳鼻喉眼学报, 2020, 34(3): 19-25.

SONG Xicheng, ZHENG Haitao. A review of autofluorescence imaging of the parathyroid gland[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(3): 19-25.

参考文献

[1] Thomas G, McWade MA, Paras C, et al. Developing a clinical prototype to guide surgeons for intraoperative label-free identification of parathyroid glands in real time[J]. Thyroid, 2018, 28(11): 1517-1531. doi:10.1089/thy.2017.0716.
[2] Christou N, Mathonnet M. Complications after total thyroidectomy[J]. J Visc Surg, 2013, 150(4): 249-256. doi:10.1016/j.jviscsurg.2013.04.003.
[3] Caron NR, Sturgeon C, Clark OH. Persistent and recurrent hyperparathyroidism[J]. Curr Treat Options Oncol, 2004, 5(4): 335-345. doi:10.1007/s11864-004-0024-4.
[4] McWade MA, Sanders ME, Broome JT, et al. Establishing the clinical utility of autofluorescence spectroscopy for parathyroid detection[J]. Surgery, 2016, 159(1): 193-202. doi:10.1016/j.surg.2015.06.047.
[5] Almquist M, Ivarsson K, Nordenström E, et al. Mortality in patients with permanent hypoparathyroidism after total thyroidectomy[J]. Br J Surg, 2018, 105(10): 1313-1318. doi:10.1002/bjs.10843.
[6] Kahramangil B, Dip F, Benmiloud F, et al. Detection of parathyroid autofluorescence using near-infrared imaging: a multicenter analysis of concordance between different surgeons[J]. Ann Surg Oncol, 2018, 25(4): 957-962. doi:10.1245/s10434-018-6364-2.
[7] Dudley NE. Methylene blue for rapid identification of the parathyroids[J]. Br Med J, 1971, 3(5776): 680-681. doi:10.1136/bmj.3.5776.680.
[8] Antakia R, Gayet P, Guillermet S, et al. Near infrared fluorescence imaging of rabbit thyroid and parathyroid glands[J]. J Surg Res, 2014, 192(2): 480-486. doi:10.1016/j.jss.2014.05.061.
[9] Kahramangil B, Berber E. The use of near-infrared fluorescence imaging in endocrine surgical procedures[J]. J Surg Oncol, 2017, 115(7): 848-855. doi:10.1002/jso.24583.
[10] Zaidi N, Bucak E, Okoh A, et al. The utility of indocyanine green near infrared fluorescent imaging in the identification of parathyroid glands during surgery for primary hyperparathyroidism[J]. J Surg Oncol, 2016, 113(7): 771-774. doi:10.1002/jso.24240.
[11] van der Vorst JR, Schaafsma BE, Verbeek FP, et al. Intraoperative near-infrared fluorescence imaging of parathyroid adenomas with use of low-dose methylene blue[J]. Head Neck, 2014, 36(6): 853-858. doi:10.1002/hed.23384.
[12] Das K, Stone N, Kendall C, et al. Raman spectroscopy of parathyroid tissue pathology[J]. Lasers Med Sci, 2006, 21(4): 192-197. doi:10.1007/s10103-006-0397-7.
[13] Paras C, Keller M, White L, et al. Near-infrared autofluorescence for the detection of parathyroid glands[J]. J Biomed Opt, 2011, 16(6): 067012. doi:10.1117/1.3583571.
[14] Solórzano CC, Thomas G, Baregamian N, et al. Detecting the near infrared autofluorescence of the human parathyroid[J]. Ann Surg, 2019: 2. doi:10.1097/sla.0000000000003700.
[15] Thomas G, Squires MH, Metcalf T, et al. Imaging or fiber probe-based approach? assessing different methods to detect near infrared autofluorescence for intraoperative parathyroid identification[J]. J Am Coll Surg, 2019, 229(6): 596-608.e3. doi:10.1016/j.jamcollsurg.2019.09.003.
[16] Ladurner R, Al Arabi N, Guendogar U, et al. Near-infrared autofluorescence imaging to detect parathyroid glands in thyroid surgery[J]. Ann R Coll Surg Engl, 2018, 100(1): 33-36. doi:10.1308/rcsann.2017.0102.
[17] McWade MA, Paras C, White LM, et al. Label-free intraoperative parathyroid localization with near-infrared autofluorescence imaging[J]. J Clin Endocrinol Metab, 2014, 99(12): 4574-4580. doi:10.1210/jc.2014-2503.
[18] Falco J, Dip F, Quadri P, et al. Cutting edge in thyroid surgery: autofluorescence of parathyroid glands[J]. J Am Coll Surg, 2016, 223(2): 374-380. doi:10.1016/j.jamcollsurg.2016.04.049.
[19] Serra C, Silveira L. Near-infrared irradiation of the thyroid area: effects on weight development and thyroid and parathyroid secretory patterns[J]. Lasers Med Sci, 2020, 35(1): 107-114. doi:10.1007/s10103-019-02800-w.
[20] Ladurner R, Sommerey S, Arabi NA, et al. Intraoperative near-infrared autofluorescence imaging of parathyroid glands[J]. Surg Endosc, 2017, 31(8): 3140-3145. doi:10.1007/s00464-016-5338-3.
[21] Kose E, Rudin AV, Kahramangil B, et al. Autofluorescence imaging of parathyroid glands: an assessment of potential indications[J]. Surgery, 2020, 167(1): 173-179. doi:10.1016/j.surg.2019.04.072.
[22] Kose E, Chomsky-Higgins KH, Kahramangil B, et al. Objective identification of parathyroid tissue using autofluorescence during thyroidectomy: a quantitative analysis[J]. J Am Coll Surg, 2018, 227(4): e119-e120. doi:10.1016/j.jamcollsurg.2018.08.323.
[23] De Leeuw F, Breuskin I, Abbaci M, et al. Intraoperative near-infrared imaging for parathyroid gland identification by auto-fluorescence: a feasibility study[J]. World J Surg, 2016, 40(9): 2131-2138. doi:10.1007/s00268-016-3571-5.
[24] Kim SW, Song SH, Lee HS, et al. Intraoperative real-time localization of normal parathyroid glands with autofluorescence imaging[J]. J Clin Endocrinol Metab, 2016, 101(12): 4646-4652. doi:10.1210/jc.2016-2558.
[25] Kim SW, Lee HS, Ahn YC, et al. Near-infrared autofluorescence image-guided parathyroid gland mapping in thyroidectomy[J]. J Am Coll Surg, 2018, 226(2): 165-172. doi:10.1016/j.jamcollsurg.2017.10.015.
[26] Benmiloud F, Rebaudet S, Varoquaux A, et al. Impact of autofluorescence-based identification of parathyroids during total thyroidectomy on postoperative hypocalcemia: a before and after controlled study[J]. Surgery, 2018, 163(1): 23-30. doi:10.1016/j.surg.2017.06.022.
[27] Ladurner R, Lerchenberger M, Al Arabi N, et al. Parathyroid autofluorescence-how does it affect parathyroid and thyroid surgery? A 5 year experience[J]. Molecules, 2019, 24(14): E2560. doi:10.3390/molecules24142560.
[28] Liu JS, Wang XX, Wang R, et al. Near-infrared auto-fluorescence spectroscopy combining with Fisher's linear discriminant analysis improves intraoperative real-time identification of normal parathyroid in thyroidectomy[J]. BMC Surg, 2020, 20(1): 4. doi:10.1186/s12893-019-0670-x.
[29] Dip F, Falco J, Verna S, et al. Randomized controlled trial comparing white light with near-infrared autofluorescence for parathyroid gland identification during total thyroidectomy[J]. J Am Coll Surg, 2019, 228(5): 744-751. doi:10.1016/j.jamcollsurg.2018.12.044.
[30] Kahramangil B, Berber E. Comparison of indocyanine green fluorescence and parathyroid autofluorescence imaging in the identification of parathyroid glands during thyroidectomy[J]. Gland Surg, 2017, 6(6): 644-648. doi:10.21037/gs.2017.09.04.
[31] Lerchenberger M, Al Arabi N, Gallwas JKS, et al. Intraoperative near-infrared autofluorescence and indocyanine green imaging to identify parathyroid glands: a comparison[J]. Int J Endocrinol, 2019, 2019: 4687951. doi:10.1155/2019/4687951.
[32] Kose E, Kahramangil B, Aydin H, et al. Heterogeneous and low-intensity parathyroid autofluorescence: Patterns suggesting hyperfunction at parathyroid exploration[J]. Surgery, 2019, 165(2): 431-437. doi:10.1016/j.surg.2018.08.006.
[33] DiMarco A, Chotalia R, Bloxham R, et al. Autofluorescence in parathyroidectomy: signal intensity correlates with serum calcium and parathyroid hormone but routine clinical use is not justified[J]. World J Surg, 2019, 43(6): 1532-1537. doi:10.1007/s00268-019-04929-9.
[34] Squires MH, Jarvis R, Shirley LA, et al. Intraoperative parathyroid autofluorescence detection in patients with primary hyperparathyroidism[J]. Ann Surg Oncol, 2019, 26(4): 1142-1148. doi:10.1245/s10434-019-07161-w.
[35] Serra C, Silveira L, Canudo A, et al. Parathyroid identification by autofluorescence-preliminary report on five cases of surgery for primary hyperparathyroidism[J]. BMC Surg, 2019, 19(1): 120. doi:10.1186/s12893-019-0590-9.
[36] Wolf HW, Grumbeck B, Runkel N. Intraoperative verification of parathyroid glands in primary and secondary hyperparathyroidism using near-infrared autofluorescence(IOPA)[J]. Updates Surg, 2019, 71(3): 579-585. doi:10.1007/s13304-019-00652-1.
[37] Squires MH, Shirley LA, Shen CL, et al. Intraoperative autofluorescence parathyroid identification in patients with multiple endocrine neoplasia type 1[J]. JAMA Otolaryngol Head Neck Surg, 2019,145(10):897-902. doi:10.1001/jamaoto.2019.1987.
[38] Benmiloud F, Godiris-Petit G, Gras R, et al. Association of autofluorescence-based detection of the parathyroid glands during total thyroidectomy with postoperative hypocalcemia risk: results of the PARAFLUO multicenter randomized clinical trial[J]. JAMA Surg, 2019,155(2):106-112. doi:10.1001/jamasurg.2019.4613.
[39] DiMarco A, Chotalia R, Bloxham R, et al. Does fluoroscopy prevent inadvertent parathyroidectomy in thyroid surgery?[J]. Ann R Coll Surg Engl, 2019, 101(7): 508-513. doi:10.1308/rcsann.2019.0065.
[40] Shinden Y, Nakajo A, Arima H, et al. Intraoperative identification of the parathyroid gland with a fluorescence detection system[J]. World J Surg, 2017, 41(6): 1506-1512. doi:10.1007/s00268-017-3903-0.
[41] McWade MA, Thomas G, Nguyen JQ, et al. Enhancing parathyroid gland visualization using a near infrared fluorescence-based overlay imaging system[J]. J Am Coll Surg, 2019, 228(5): 730-743. doi:10.1016/j.jamcollsurg.2019.01.017.
[42] Mannoh EA, Thomas G, Solórzano CC, et al. Intraoperative assessment of parathyroid viability using laser speckle contrast imaging[J]. Sci Rep, 2017, 7(1): 14798. doi:10.1038/s41598-017-14941-5.
[43] Mondal SB, Gao SK, Zhu N, et al. Optical see-through cancer vision goggles enable direct patient visualization and real-time fluorescence-guided oncologic surgery[J]. Ann Surg Oncol, 2017, 24(7): 1897-1903. doi:10.1245/s10434-017-5804-8.
[44] Mondal SB, Gao SK, Zhu N, et al. Binocular Goggle Augmented Imaging and Navigation System provides real-time fluorescence image guidance for tumor resection and sentinel lymph node mapping[J]. Sci Rep, 2015, 5: 12117. doi:10.1038/srep12117.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed