纳米碳在甲状腺全切联合Ⅵ区淋巴清扫术中的应用研究

Application of carbon nano-particles in total thyroidectomy combined with lymphadenectomy in area Ⅵ

目的探讨在甲状腺乳头状癌全切联合Ⅵ区淋巴清扫术中应用纳米碳混悬注射液对甲状旁腺保护及淋巴清扫的作用。方法回顾性分析南京医科大学附属肿瘤医院头颈外科2016年4月至2018年1月完成的194例接受甲状腺全切+Ⅵ区淋巴清扫术的甲状腺乳头状癌患者,其中术中应用纳米碳的作为纳米碳组104例,常规手术的作为对照组90例。比较两组患者Ⅵ区及右侧Ⅵb区淋巴清扫数量、转移淋巴结数、术后(1 d、3 d、1个月及6个月)低钙血症及甲状旁腺功能减退发生率以及甲状旁腺误切率。采用卡方和秩和检验对数据进行分析。结果两组患者在年龄、性别、肿瘤大小、手术时间、肿瘤是否外侵以及是否多灶等方面比较差异无统计学意义,两组患者出现暂时性甲状旁腺功能减退的例数分别为纳米碳组28例(26.9%),对照组41例(45.5%),差异有统计学意义(χ^2=7.3,P=0.007),纳米碳组出现2例(1.9%)甲状旁腺误切,对照组出现8例(8.9%)甲状旁腺误切,差异有统计学意义(χ^2=4.9,P=0.026)。两组清扫出的Ⅵ区淋巴结枚数分别为791枚和536枚(Z=-2.2,P=0.028),右侧Ⅵb区淋巴结枚数分别为93枚和41枚(Z=-2.1,P=0.034),差异均有统计学意义。结论纳米碳在甲状腺乳头状癌甲状腺全切联合Ⅵ区淋巴清扫术中可以有效辨识及保护甲状旁腺,预防术后甲状旁腺功能低下的发生,并提高Ⅵ区淋巴结的清扫效果。

Objective To evaluate the effects of staining with carbon nanoparticles on the identification of parathyroid glands and lymph nodes during thyroid carcinoma surgery combined with lymphadenectomy.Methods A total of 194 patients with papillary thyroid carcinoma who underwent thyroidectomy combined with lymphadenectomy from April 2016 to January 2018 were reviewed. Of them 104 cases were injected with carbon nanoparticles in operation area (nanocarbon group) and other 90 cases without the injection of carbon nanoparticles were as control group. The incidence of mistakenly dissection of parathyroid glands and the levels of serum calcium and parathyroid hormone in 1 day, 3 days, 1 month and 6 months after surgery were compared between two groups of patients. Chisquare and ranksum test were used to analyze 2 data.Results There were no significant differences in age, gender, tumor size, operation time, extrathyroidal invasion and multifocality between two groups. Compared with control groups, nanocarbon group showed a significantly lower incidence of mistakenly dissection of parathyroid glands (8 cases vs 2 cases, 8.9% vs 1.9%,χ^2=4.9, P=0.026) and a significantly lower incidence of hypoparathyroidism (41 cases vs 28 cases, 45.5% vs 26.9%, χ^2=7.3, P=0.007). The number of lymph nodes dissected from central compartment was 791 in nanocarbon group and 536 in control groups, with a statistically significant difference (Z=-2.2, P=0.028). There was a significant difference in the number of lymph nodes removed from the right neck Ⅵb level between nanocarbon group and control group (41 nodes vs 93 nodes, Z=-2.1, P=0.034).Conclusion Treatment with nanocarbon can significantly facilitate the identification of the parathyroid during total thyroidectomy combined with central compartment lymphadenectomy, reduce the incidence of postoperative hypoparathyroidism, and improve the dissection of lymph node in the central compartment.