Intraoperative strategies in identification and functional protection of parathyroid glands for patients with thyroidectomy: a systematic review and network meta-analysis

作者全名："Lu, Dengwei; Pan, Bin; Tang, Enjie; Yin, Supeng; Sun, Yiceng; Yuan, Yuquan; Yin, Tingjie; Yang, Zeyu; Zhang, Fan"

作者地址："[Lu, Dengwei; Pan, Bin; Yin, Supeng; Sun, Yiceng; Yuan, Yuquan; Yin, Tingjie; Yang, Zeyu; Zhang, Fan] Chongqing Gen Hosp, Dept Breast & Thyroid Surg, Chongqing, Peoples R China; [Lu, Dengwei] Chongqing Univ FuLing Hosp, Thyroid & Breast Surg, Chongqing, Peoples R China; [Pan, Bin; Yuan, Yuquan; Yin, Tingjie; Yang, Zeyu; Zhang, Fan] Chongqing Med Univ, Grad Sch Med, Chongqing, Peoples R China; [Tang, Enjie] Third Mil Med Univ, Army Med Univ, Coll Prevent Med, Epidemiol Dept, Chongqing, Peoples R China"

通信作者："Yang, ZY; Zhang, F (通讯作者)，Liangjiang New Area, 118 Xingguang Ave, Chongqing 401147, Peoples R China."

来源：INTERNATIONAL JOURNAL OF SURGERY

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:001185065100044

JCR分区：Q1

影响因子：12.5

年份：2024

卷号：110

期号：3

开始页：1723

结束页：1734

文献类型：Article

关键词：Autofluorescence; carbon nanoparticles; indocyanine green fluorescence; parathyroid gland; thyroid surgery

摘要："Background:This study aimed to assess the benefits and limitations of four intraoperative visualization of parathyroid gland (IVPG) strategies in the identification and functional protection of parathyroid glands (PGs).Methods:We searched PubMed, the Cochrane Central Register of Controlled Trials, CNKI, EMBASE, Web of Science and Google Scholar databases until 30 June 2023. Four IVPG strategies were composed of the naked eyes (NE) and three imaging strategies: autofluorescence (AF), indocyanine green fluorescence (ICGF), and carbon nanoparticles (CN). We performed a pairwise meta-analysis (PMA) for direct comparisons and a Bayesian network meta-analysis (NMA) for indirect comparisons.Results:A total of 29 eligible studies were included. According to NMA and PMA, AF had significantly lower rates of postoperative hypocalcemia and hypoparathyroidism, PG inadvertent resection, and PG auto-transplantation compared to NE, while had significantly higher rate of PG identification. CN showed significantly lower rates of postoperative hypocalcemia and hypoparathyroidism, and PG inadvertent resection compared to NE in PMA and NMA. ICGF showed a significantly higher rate of PG auto-transplantation compared to NE in PMA and AF in NMA. According to SUCRA values, AF showed the best advantage in reducing the rate of postoperative hypocalcemia (0.85) and PG inadvertent resection (0.89), and increasing the rate of PG identification (0.80). CN had the greatest advantage in reducing the rate of postoperative hypoparathyroidism (0.95). ICGF ranked the highest in the rate of PG auto-transplantation (0.98).Conclusions:Three imaging strategies demonstrate significant superiority over NE in the intraoperative PG identification and functional protection. AF is the best strategy in reducing the incidence of postoperative hypocalcemia, increasing the rate of PG identification, and reducing the rate of PG inadvertent resection and auto-transplantation. ICGF has great value in assessing PG viability, leading to the trend towards PG auto-transplantation. CN is the best strategy in reducing the incidence of postoperative hypoparathyroidism."

基金机构："Basic Research and Frontier Exploration Project of Yuzhong District, Chongqing, China [20210162]; Chongqing Technology Innovation and Application Development Special Social Development Field Key Projects [CSTB2022TIAD-KPX0177]"

基金资助正文："This work was supported by the Basic Research and Frontier Exploration Project of Yuzhong District, Chongqing, China(Grant No. 20210162), and the Chongqing Technology Innovation and Application Development Special Social Development Field Key Projects (Grant No. CSTB2022TIAD-KPX0177)."