近红外自体荧光成像在甲状腺手术中识别甲状旁腺的价值：48例回顾性对照研究
程璇1 洪晨1 左朝阳2 杨林1（通信作者）

1西电集团医院，陕西西安，‌710077；

2西京学院，陕西西安，710123；

摘要：目的：评价近红外自体荧光成像（near-infrared autofluorescence，NIRAF）结合增强现实原位投影在甲状腺手术中识别甲状旁腺的价值。方法：回顾性纳入甲状腺手术患者48例，按本院启用NIRAF时间先后分组：启用前连续24例为对照组，术中依靠肉眼辨认；启用后连续24例为荧光组，加用NIRAF探查及原位投影辅助跟踪定位。以甲状旁腺识别数占预期暴露数的比例为主要指标，术后血清总钙及低钙血症发生率为次要指标。结果：荧光组识别率高于对照组（97.9%比68.8%，P＜0.001）；识别全部预期暴露甲状旁腺者22例比8例（P＜0.001），每例未识别数目由0.79枚降至0.08枚。术后血清总钙组间差异无统计学意义（P=0.285），低钙血症发生率8.3%比16.7%（P=0.666）。结论：NIRAF 结合增强现实原位投影技术可有效提高甲状旁腺识别率，有助于医生术中定位与保护保护甲状旁腺。术后低钙血症发生率由16.7%降至8.3%，但低钙血症事件数较少，组间差异无统计学意义。

关键词：甲状腺切除术；甲状旁腺；近红外自体荧光成像；原位投影；增强现实

参考文献

[1]Canali L,Russell MD,Sistovaris A,et al.Camera-based near-infrared autofluorescence versus visual identification in total thyroidectomy for parathyroid function preservation: systematic review and meta-analysis of randomized clinical trials[J].Head Neck,2025,47(1):225-234.

[2]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.

[3]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,2020,155(2):106-112.

[4]Javed A,Alburaiki A,Sharma N,et al.Utilisation of near infrared autofluorescence in parathyroid identification during thyroidectomy:a systematic review and meta-analysis of randomised controlled trials[J].Clin Otolaryngol,2025,50(4):609-618.

[5]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.