纳米炭示踪与改良Miccoli技术在甲状腺乳头状癌全甲状腺切除术中的应用及比较

Application of nanocarbon tracer and modified Miccoli procedure in total thyroidectomy for patients with papillary thyroid carcinoma and their comparison

目的:探讨并比较纳米炭示踪技术与改良内镜辅助甲状腺切除术(Miccoli术)应用于甲状腺乳头状癌(PTC)全甲状腺切除术中的效果及对甲状旁腺功能的保护作用。方法:回顾性分析117例接受全甲状腺切除术PTC患者的临床资料,其中31例术中采用纳米炭标记(纳米炭组),56例采用改良Miccoli手术(Miccoli组),30例采用常规手术(常规组)。比较各组的手术指标、手术前后的血钙与甲状旁腺激素(PTH)水平、术后视觉模拟评分(VAS)与数字评分系统(NSS),以及术后暂时性或永久性喉上神经(SLN)损伤、喉返神经(RLN)损伤、甲状旁腺功能降低、低钙血症及甲状腺癌复发情况。结果:各组患者术前资料具有可比性。Miccoli组手术时间明显长于另两组,但切口长度、术中出血及术后引流量明显少于另两组(均P<0.05),各组淋巴结清扫数、术后住院时间无明显差异(均P>0.05),但纳米炭组淋巴结受累检出率明显高于常规组(P<0.05)。术后1 h至7 d,纳米炭组和Miccoli组血钙及PTH水平明显高于常规组(均P<0.05),但前两组间无统计学差异(均P>0.05);Miccoli组VAS明显低于另两组,且纳米炭组低于常规组(均P<0.05)。术后1个月,各组血钙和PTH水平及VAS均无明显差异(P>0.05)。术后3、6个月,Miccoli组的NSS明显低于另两组,而纳米炭组明显低于常规组(均P<0.05)。所有患者均获得随访,随访时间为18～41个月。各组SLN损伤率无统计学差异(P>0.05);纳米炭组与Miccoli组RLN损伤、甲旁减、低钙血症发生率均明显低于常规组(均P<0.05),但纳米炭组与Miccoli组间比较差异无统计学意义(均P>0.05);各组的复发率差异无统计学意义(P>0.05)。结论:纳米炭与改良Miccoli术用于PTC全甲状腺切除术均能够有效保护患者的甲状旁腺功能,纳米炭技术的淋巴结清扫彻底性更好,而改良Miccoli技术更为微创。

Objective:To investigate and compare the efficacy of using nanocarbon tracer technique and modified endoscopic-assisted thyroidectomy(Miccoli surgery)and their parathyroid protection effects in total thyroidectomy for patients with papillary thyroid carcinoma(PTC). Methods:The clinical data of117PTC patients undergoing total thyroidectomy were retrospectively analyzed. Of the patients,31cases underwent nanocarbon mark during operation(nanocarbon group),56cases underwent modified Miccoli surgery(Miccoli group),and the other30cases underwent conventional surgery(conventional group).The surgical variables,pre-and postoperative serum levels of calcium and parathyroid hormone(PTH), postoperative scores of visual analogue scale(VAS)and numerical scoring system(NSS),and the incidence of transient or permanent superior laryngeal nerve(SLN)and recurrent laryngeal nerve(RLN)injuries,as well as the occurrence of hypoparathyroidism,hypocalcemia and tumor recurrence were compared among the three groups. Results:The preoperative data were comparable among the three groups.The operative time was significantly prolonged,but the length of incision and intraoperative blood loss and amount of postoperative drainage were significantly reduced in Miccoli group compared with the other two groups(all P<0.05).There were no significant differences in number of lymph node dissected and length of postoperative hospital stay among the three groups (P>0.05),but the number of metastatic lymph nodes detected in nanocarbon group was significantly higher than that in conventional group(P<0.05).On 1h to7d after operation,the serum calcium and PTH levels in both nanocarbon group and Miccoli group were significantly higher than those in conventional group(all P<0.05), while no significant differences were noted between the former two groups(all P>0.05);the VAS scores in Miccoli group were significantly lower than those in the other two groups,and in nanocarbon group were significantly lower than those in conventional group(all P<0.05).There were no significant differences in serum calcium and PTH levels as well as VAS scores among the three group at one month after operation(all P>0.05).At3and 6months after operation,the NSS scores in Miccoli group were significantly lower than those in the other two groups,and in nanocarbon group were significantly lower than those in conventional group(all P<0.05).All patients were followed up for18to41months.There was no significant difference in incidence of SLN injury among the three groups(P>0.05);the incidence of RLN injury,hypoparathyroidism and hypocalcemia in either nanocarbon group or Miccoli group were significantly lower than those in conventional group(all P<0.05),but all showed no significant differences between nanocarbon group and Miccoli group(all P>0.05).The recurrence rates had no significant differences among the three groups(P>0.05). Conclusion:The nanocarbon technique and modified Miccoli procedure can both effectively protect the parathyroid function in total thyroidectomy for PTC patients.The nanocarbon technique has better thoroughness in lymph node dissection,while the modified Miccoli procedure is more minimally invasive.