ketendoКлиническая и экспериментальная тиреоидологияClinical and experimental thyroidology1995-54722310-3787Endocrinology Research Centre10.14341/ket20095135-40ketendo-4487Research ArticleСтатьиArticlesФотодинамическая визуализация околощитовидных желез – результаты клинического примененияPhotodynamic Vvisualisation of Paratyroid Glands – Results of Clinical use EngSlepzovI Vnewsurgery@yandex.ruBubnovA N-ChernikovR A-FedotovYu N-SemenovA A-ChinchukI K-MakarynV A-UspenskayaA A-KarelinaYu V-20091503200951ТОМ 5, №1 (2009)3540Copyright © Slepzov I.V., Bubnov A.N., Chernikov R.A., Fedotov Y.N., Semenov A.A., Chinchuk I.K., Makaryn V.A., Uspenskaya A.A., Karelina Y.V., 20092009Slepzov I.V., Bubnov A.N., Chernikov R.A., Fedotov Y.N., Semenov A.A., Chinchuk I.K., Makaryn V.A., Uspenskaya A.A., Karelina Y.V.Slepzov I.V., Bubnov A.N., Chernikov R.A., Fedotov Y.N., Semenov A.A., Chinchuk I.K., Makaryn V.A., Uspenskaya A.A., Karelina Y.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.cet-endojournals.ru/jour/article/view/4487

Цель исследования. Клиническая апробация методики интраоперационной фотодинамической визуализации околощитовидных желез.Материал и методы. Было обследовано 25 пациентов с заболеваниями щитовидной и околощитовидных желез, которым за 2–3 ч до операции перорально вводили 1,5 г 5-аминолевулиновой кислоты в виде водного раствора. Проводилось оперативное вмешательство в условиях затемненной операционной: видеоассистированная гемитиреоидэктомия (9), видеоассистированная тиреоидэктомия (1), гемитиреоидэктомия (7), тиреоидэктомия (2), тиреоидэктомия с центральной шейной лимфодиссекцией (3), видеоассистированное удаление аденомы околощитовидной железы (3). После ревизии полости шеи проводилось облучение поверхности операционной раны синим светом с использованием источника света KARL STORZ D-Light C (длина волны – 380–440 нм) и эндоскопа с системой фильтров. В преди послеоперационном периоде регистрировались основные клинические показатели, проводился мониторинг уровня паратгормона и ионизированного кальция до операции, через 24, 48 ч, 1 мес после операции.Результаты. Интраоперационно удалось визуализировать околощитовидные железы у 23 из 25 пациентов. Во всех указанных случаях регистрировалось розово-оранжевое свечение околощитовидных желез в лучах синего света. Было отмечено интенсивное свечение аденом ОЩЖ при первичном гиперпаратиреозе. Интенсивность свечения аденомы ОЩЖ была значительно выше, чем свечения нормальных ОЩЖ. Случаев возникновения аллергических реакций и фототоксических дерматитов и других побочных эффектов от приема 5-АЛК не было выявлено.Вывод: визуализация околощитовидных желез при пероральном назначении 5-аминолевулиновой кислоты возможна у подавляющего большинства пациентов.

The purpose: an approbation of intraoperative photodynamic identification of healthy and adenomatous parathyroid glands using 5-aminolevulinic acid (5-ALA) at thyroid and parathyroid operations.Materials and methods: intraoperative photodynamic identification using 5-ALA was performed in 25 patients with various thyroid and parathyroid diseases. 2–3 hours before the surgery the patients have received 1,5 g of 5-ALA per os. In 10 cases video-assisted operations were performed. In 3 cases at primary hyperparathyroidism video-assisted parathyroidectomy was used. In other cases the operative intervention was carried out using conventional technique. The operative wound surface was exposed to blue light of the light source KARL STORZ D-Light C (wavelength –380–440 nm) and the endoscope with the system of filters. During preand postoperative period we have been registering basic clinical parameters, including parathyroid hormone level and the level of ionized calcium monitoring before operation, in 24, 48 hours and 1 month after operation. Results: the parathyroid glands were identified in 23 of 25 patients. There were no cases of allergic reactions and other side effects of 5-ALA introduction.Conclusion: intraoperative parathyroid glands identification by the way of registration of their fluorescence at peroral administration of 5-aminolevulinic acid is possible for the overwhelming majority of patients.

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The authors declare that there are no conflicts of interest present.