甲状腺手术中自体荧光和/或吲哚菁绿的应用：欧洲内分泌外科医师学会（ESES）建议。
完整摘要 · 中文译文
背景：术后甲状旁腺功能减退症仍然是甲状腺全切除术后最常见的并发症。最近，已引入联合或不联合吲哚菁绿（ICG）的近红外自发荧光（NIRAF）成像，用于在手术过程中评估甲状旁腺。本文旨在基于一项范围综述和荟萃分析，提供欧洲内分泌外科医师协会（ESES）关于其在甲状腺手术中应用的推荐意见。 方法：ESES成立了一个专家工作组。使用 MEDLINE®（PubMed）进行了系统性文献检索，检索截至2024年12月31日。如果使用比较组来评估短期和长期术后甲状旁腺功能减退症、自体移植率和/或意外切除甲状旁腺，则纳入这些研究。结果采用随机效应荟萃分析进行合并。进行了亚组分析，以评估联合或不联合 ICG 的 NIRAF 以及中央区颈淋巴结清扫术的影响。推荐意见由所有共同作者共同制定，并在第11届 ESES 大会上讨论。全体成员参与的改良德尔菲在线投票流程批准了所有推荐意见。 结果：在筛选335篇摘要后，共有34项研究、总计9322例患者符合纳入标准。这些研究发表于2017年至2024年，并包括11项随机对照试验（RCTs）。荟萃分析显示，NIRAF和ICG在即时性和永久性甲状旁腺功能减退症、意外切除比例和自体移植比例方面显示出有前景的结果。证据质量被评为 'mode 对于大多数问题，多数建议的证据质量良好，推荐等级为“强烈推荐”。 结论：这些ESES建议基于文献范围综述、荟萃分析和专家意见，为使用或不使用ICG的NIRAF提供了指导。
完整摘要 · 英文原文
BACKGROUND: Postoperative hypoparathyroidism remains the most frequent complication after total thyroidectomy. Recently, near-infrared autofluorescence (NIRAF) imaging with or without indocyanine green (ICG) was introduced to evaluate parathyroid glands during surgery. The aim of this paper is to provide recommendations by the European Society of Endocrine Surgeons (ESES) regarding its use in thyroid surgery based on a scoping review and meta-analysis. METHODS: A working group of experts was created by the ESES. A systematic literature search was performed, using MEDLINE® (PubMed), up to 31 December 2024. Studies were included if a comparative group was used to evaluate short- and long-term postoperative hypoparathyroidism, autotransplantation rates, and/or inadvertent parathyroid gland removal. The results were pooled in a random-effects meta-analysis. Subgroup analyses were performed to assess the impact of NIRAF with or without ICG, as well as central lymph node neck dissection. Recommendations were created among all co-authors and discussed at the 11th ESES conference. A modified Delphi online voting process amongst all members approved all recommendations. RESULTS: After screening 335 abstracts, there were 34 studies, with a total of 9322 patients, that met the inclusion criteria. These were published between 2017 and 2024 and included 11 RCTs. Meta-analyses showed promising results for NIRAF and ICG with regard to immediate and permanent hypoparathyroidism, inadvertent removal proportions, and autotransplantation proportions. The quality of evidence was rated as 'moderate' for most of the recommendations with good quality of evidence for most questions. CONCLUSION: These ESES recommendations provide guidance for the use of NIRAF with or without ICG based on a scoping review of the literature, meta-analyses, and expert opinion.