ỨNG DỤNG HUỲNH QUANG BẢO TỒN TUYẾN CẬN GIÁP TRONG PHẪU THUẬT TUYẾN GIÁP

Abstract

Objective: To evaluate the outcomes of fluorescence-guided techniques for parathyroid gland preservation during thyroidectomy. Methods: A scoping review. A literature search was conducted using the PubMed and ScienceDirect databases to identify, screen, and analyze relevant studies. Selected articles were synthesized to assess the effectiveness of intraoperative fluorescence imaging in identifying and preserving parathyroid glands during thyroid surgery. Results: Thirteen studies published between 2015 and 2025 were included. Among them, four were randomized controlled trials (RCTs), one was a case series, seven were prospective studies, and one employed a bidirectional design (both retrospective and prospective). Two studies demonstrated that near-infrared autofluorescence (NIRAF) improved parathyroid gland detection rates compared to visual inspection. Three studies reported that NIRAF significantly reduced the incidence of transient postoperative hypocalcemia (p < 0.05), and one study confirmed that NIRAF achieved 100% accuracy in parathyroid identification when compared with histopathological results. Five studies showed that indocyanine green fluorescence angiography (ICGFA) effectively predicted the risk of postoperative hypoparathyroidism and proposed objective qualitative and quantitative perfusion scoring systems. The combined use of NIRAF and ICGFA demonstrated superior outcomes, including a reduction in transient hypoparathyroidism from 43.3% to 27.8% (p = 0.029) and a significant increase in the number of glands preserved in situ (p < 0.001). Conclusion: Fluorescence imaging is becoming an essential tool for parathyroid gland preservation during thyroidectomy. The integration of multimodal fluorescence technologies and digital image processing paves the way for real-time parathyroid mapping, thereby optimizing surgical outcomes and enhancing postoperative safety for patients.