光电检测仪在甲状腺癌术中的初步应用

doi:10.6040/j.issn.1671-7554.0.2025.0553

摘要/Abstract

摘要： 目的探讨甲状腺术中光电检测仪使用近红外自体荧光显像(near-infrared autofluorescence, NIRAF)和术中神经监测(intraoperative neural monitoring, IONM)技术在甲状腺癌术中的安全性和实用性,并分析其对术后并发症的影响。方法选取中国人民解放军联勤保障部队第九六〇医院2025年1月至3月使用甲状腺术中光电检测仪(兼具NIRAF和IONM技术)进行手术的甲状腺癌患者21例。依次通过经验判断和光电检测仪识别甲状旁腺,以术后石蜡病理检查为金标准。使用检测仪监测喉返神经功能,观察术后并发症。结果通过经验判断和术中光电检测仪共同识别可疑甲状旁腺101枚,术中光电检测仪检测的灵敏度、特异度、准确率分别为 97.6%、91.7%、94.1%;经验判断对应指标分别为61.0%、75.0%、69.3%。以患者为单位行准确率差异性分析,差异有统计学意义(Z=-3.91,P<0.001)。IONM术中信号稳定率为100%,术后振幅较基线波动中位下降比例为3%(-1.5%,6.5%)。喉返神经(recurrent laryngeal nerve, RLN)术后未出现损伤,根据精确二项分布计算神经损伤的95%CI为(0%,13.3%)。结论光电检测仪作为整合NIRAF和IONM两种技术于一体的新型检测设备,应用于甲状腺术中可精准识别并有效保护甲状旁腺和神经,有效减少术后并发症。

关键词: 甲状腺癌, 近红外自体荧光显像, 术中神经监测, 甲状旁腺, 喉返神经

Abstract: Objective To explore the safety and practicality of using near-infrared autofluorescence(NIRAF)and intraoperative neural monitoring(IONM)techniques in thyroid surgery for thyroid cancer, and to assess their impact on postoperative complications. Methods Twenty-one patients with thyroid cancer who underwent surgery at the 960th Hospital of the PLA Joint Logistics Support Force of China from January to March 2025 were enrolled. The intraoperative photoelectric detection device(equipped with NIRAF and IONM technologies)was used for thyroid surgery. The parathyroid glands were successively identified by empirical judgment and photodetection instrumentwith postoperative paraffin pathological examination as the gold standard. The function of the recurrent laryngeal nerve was monitored by the detection instrument, and postoperative complications were observed. Results A total of 101 suspicious parathyroid glands were identified using a combination of experience-based judgment and intraoperative photoelectric detection. The sensitivity, specificity, and accuracy of intraoperative photoelectric detection were 97.6%, 91.7%, and 94.1%, respectively; the corresponding indicators for experience-based judgment were 61.0%, 75.0%, and 69.3%, respectively. Per patient analysis revealed a statistically significant difference in diagnostic accuracy(Z=-3.91,P< 0.001). The intraoperative signal stability rate of IONM was 100.0%, and the median amplitude decreased by 3% from baseline postoperatively(IQR: -1.5% to 6.5%). No postoperative recurrent laryngeal nerve injury was observed, yielding a 95% confidence interval for nerve injury of 0% to 13.3% based on the exact binomial distribution. Conclusion The photoelectric detector, a novel device integrating NIRAF and IONM technologies, enables accurate identification and effective protection of parathyroid glands and nerves during thyroid surgery, thereby reducing postoperative complications.

Key words: Thyroid carcinoma, Near-infrared autofluorescence imaging, Intraoperative nerve monitoring, Parathyroid gland, Recurrent laryngeal nerve

中图分类号:

R736.1

李儆修,李忠慧,李闻天,王宇男,宋泽辉,庄大勇,贺青卿,周鹏. 光电检测仪在甲状腺癌术中的初步应用[J]. 山东大学学报 (医学版), 2026, 64(4): 31-37.

LI Jingxiu, LI Zhonghui, LI Wentian, WANG Yunan, SONG Zehui, ZHUANG Dayong, HE Qingqing, ZHOU Peng. Preliminary application of photoelectric detection devices in thyroid cancer surgery[J]. Journal of Shandong University (Health Sciences), 2026, 64(4): 31-37.

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