甲状腺淋巴示踪技术对甲状旁腺保护作用的研究

Thyroid lymphography： a new clinical approach for protecting parathyroid in surgery

目的研究和比较淋巴示踪剂在甲状腺乳头状癌手术对甲状旁腺的保护作用。方法选取符合人组标准的121例甲状腺乳头状癌患者，在行甲状腺全切和中央区淋巴清扫手术时分为常规手术组（40例）和示踪组（81例），示踪组又分为纳米炭组（48例）和亚甲蓝组（33例），示踪组术中注射0．2m示踪剂，直视下显露并原位保护甲状旁腺及其血供，观察并记录3组患者甲状旁腺的数量、染色情况、是否出现缺血。术后行病理学检查验证甲状旁腺误切率，监测血钙及血甲状旁腺激素值比较术后低钙血症发生率。结果甲状腺淋巴示踪未发生过敏反应和其他并发症。纳米炭组的甲状旁腺误切率为1．37％（2／146），亚甲蓝组为2．62％（2／97），常规手术组7．14％（6／84），三组比较差异有统计学意义（χ2=17．372，P〈0．05）；三组患者术后低钙血症发生率纳米炭组为10．4％（5／48），亚甲蓝组9．1％（3／33），低于常规组的17．5％（7／40），差异有统计学意义（χ2=0．671，P=0．037）；三组平均显露甲状旁腺枚数纳米炭组（3．1±0．3）枚，亚甲蓝组（2．9±0．4）枚，与常规手术组（2．3±0．3）枚相比，差异有统计学意义（F=3．78，P〈0．01）。结论在行甲状腺全切时应用淋巴示踪剂可起到保护甲状旁腺的作用。

Objective To research the role of lymph tracers to protect parathyroid in surgery for papillary thyroid carcinoma. Methods Patients with papillary thyroid carcinoma who met selected criteria were enrolled in this study. Patients were divided into carbon nanoparticle group, methylene blue group, and conventional surgery group. Results No significant complication occurred in the patients of carbon nanoparticle and methylene blue groups. In carbon nanoparticle group, methylene blue group and conventional surgery group, the mean numbers of parathyroid glands detected during surgery were 3.1 ± 0.3, 2.9± 0.4 and 2.3 0.3 （ F = 3.78,P 〈 0.01 ） , the rates that parathyroid was cut mistakenly were 1.37% （2/146） ,2.62% （2/97） and 7.14% （6/84） respectively（ χ2 = 17. 372,P 〈 0.05 ） ; and the incidence of postoperative hypocalcemia were 10.4% （ 5/48 ） , 9. 1% （ 3/33 ） and 17.5% （ 7/40,χ2 = 0. 671, P = 0. 037）. Conclusion Thyroid lymphography technique is helpful to protect from the injury to the parathyroid glands in surgery.