纳米碳混悬注射液提高cN0甲状腺乳头状癌手术精准性的临床应用

Clinical application of carbon nanoparticles suspension in improving accuracy of cN0 thyroid papillary carcinoma surgery

目的探讨纳米碳混悬注射液对提高c N0甲状腺乳头状癌手术精准性的应用价值。方法回顾性分析2016年6月～2017年6月在天津市第四中心医院甲状腺乳腺外科手术治疗的c N0甲状腺乳头状癌患者的临床资料98例,随机分为实验组50例和对照组48例。两组均采用精细被膜解剖法,实验组术中在甲状腺真被膜下注射纳米碳悬浊液。比较两组甲状旁腺术中显露情况,甲状旁腺误切情况、手术后24 h血清钙离子和甲状旁腺激素E(parathyroid hormone,PTH)情况及喉返神经损伤情况。结果实验组甲状旁腺显露111枚,对照组93枚(P <0. 05);实验组2例甲状旁腺误切,误切率4%(2/50),对照组9例甲状旁腺误切,误切率18. 75%(9/48)(P <0. 05);实验组暂时性PTH减低4%(2/50),对照组暂时性PTH减低22. 9%(11/48)(P <0. 05);实验组暂时性低钙血症6%(3/50),对照组27. 1%(13/48)(P <0. 05);实验组暂时性喉返神经损伤6%(3/50),对照组20. 83%(10/48)(P <0. 05)。结论纳米碳混悬注射液能够提高手术中甲状旁腺的辨识度,减少甲状旁腺的误切,保护甲状旁腺的功能,能够在一定程度上提高喉返神经的辨识度。

Objective To explore the application of carbon nanoparticles suspension in improving the accuracy of thyroid papillary carcinoma surgery. Methods Clinical data of 98 patients with c N0 thyroid papillary carcinoma surgically treated in our department from June 2016 to June 2017 were analyzed retrospectively. All the patients were randomly divided into experimental group( n = 50) and control group( n = 48). The meticulous capsular dissection technique was adopted for both groups with intraoperative subcapsular injection of carbon nanoparticles suspension in the experimental group. The intraoperative exposure and incidental resection of parathyroid,recurrent laryngeal nerve injury as well as serum levels of calcium and parathyroid hormne( PTH) 24 hours after operation were compared between the two groups. Results111 parathyroid glands were founded in the experimental group and 93 in the control group( P < 0. 05). Incidental parathyroidectomy occurred in 2 cases( 4%,2/50) of the experimental group and 9( 18. 75%,9/48) of the control group( P < 0. 05). The incidences of temporary PTH reduction and hypocalcemia were 4%( 2/50) and 6%( 3/50) respectively in the experimental group,and those in the control group were 22. 9%( 11/48) and 27. 1%( 13/48),their differences between the two groups were statistically significant( both P < 0. 05). Temporal recurrent laryngeal nerve injury occurred in3 case s( 6%) of the experimental group and 10( 20. 83%) of the control group( P < 0. 05). Conclusion Intraoperative subcapsular injection of carbon nanoparticles suspension can significantly improve the identification of parathyroid gland during thyroid cancer surgery and improve the recognition of recurrent laryngeal nerve to a certain degree.