影像学评估结合纳米碳在甲状腺癌淋巴结处理中的作用

The role of medical imaging plus carbon nanoparticles to manage the cervical lymph nodes in patients with thyroid carcinoma

目的:探讨术前影像学评估结合术中应用纳米碳在甲状腺癌淋巴结处理中的作用。方法:收集81例初治的甲状腺癌患者的临床资料,分为实验组(42例)和对照组(39例)。根据术前彩超结合增强CT评估及病理检查结果,分别行中央区清扫及择区性Ⅲ、Ⅳ区清扫或侧颈区清扫。实验组在甲状腺注入纳米碳,分别计数3种清扫方式的淋巴结总数、转移数、黑染数及黑染转移数,对照组分别计数3种清扫方式的淋巴结总数、转移数;检查2组甲状腺及中央区清扫标本中有无甲状旁腺。结果:实验组中央区及Ⅲ、Ⅳ区和侧颈区清扫标本淋巴结黑染率分别为80.0%、54.9%及39.1%。在中央区清扫标本中,对照组、实验组平均每侧检出的淋巴结数为(3.03±2.07)枚、(4.72±2.97)枚,差异有统计学意义(P<0.01);在Ⅲ、Ⅳ区清扫标本中,对照组、实验组平均每侧检出的淋巴结数为(5.53±3.78)枚、(10.29±3.36)枚,差异有统计学意义(P<0.01);在侧颈区清扫标本中,对照组、实验组平均每侧检出的淋巴结数为(13.40±9.67)枚、(14.56±6.28)枚,差异无统计学意义(P>0.05)。3种清扫方式平均每侧检出的转移淋巴结数实验组和对照组比较均差异无统计学意义(均P>0.05)。实验组68侧甲状腺或中央区清扫标本中有3侧检出甲状旁腺,对照组60侧甲状腺或中央区清扫标本中有9侧检出甲状旁腺,2组比较差异有统计学意义(P<0.05)。结论:纳米碳在中央区清扫及侧颈区cN0者行择区性Ⅲ、Ⅳ区清扫时可以较好地标记淋巴结,提高了淋巴结检出率;侧颈区cN+者,纳米碳没有提高淋巴结的检出率。纳米碳在甲状腺腺叶切除及中央区清扫时可以有效区别和保护甲状旁腺。

Objective：The purpose of this study was to discuss the role of the combination of carbon nanoparti- cles and medical imaging to manage the cervical lymph nodes in patients with thyroid carcinoma. Method： Eighty one patients with thyroid carcinoma that primary treated were divided into two groups： trial group and control group. Carbon nanoparticles were injected into the thyroid gland of trial group patients. Central compartment （level VI ） dissection, levels III and IV dissection, lateral node （levels II-V ） dissection were performed respectively in all the patients on the basis of medical imaging and pathology. Total lymph nodes, metastasis lymph nodes, black stained lymph nodes and black stained metastasis lymph nodes of trial group were counted respectively in different dissection specimens. Total lymph nodes and metastasis lymph nodes of control group were counted respectively in different dissection specimens. Parathyroid glands of thyroid or central compartment dissec- tion specimens were counted in two groups. Result：In trial group, rate of staining lymph node was 80.0% in central neck dissection tissue, 54.9% in levels III and IV dissection specimen, 39.1% in lateral node dissection specimen. In central compartment dissection tissue, lymph nodes on average in control group were less than in trial group （3.03±2.07 vs. 4.72±2.97） （P〈0.01）. The same was in levels III and IV dissection specimen （5.53± 3.78 vs. 10.29±3.36）（P〈0.01）. As for lateral node dissection specimen, there was no statistic difference in the two group （13.4±9.67 vs. 14. 564±6.28） （P〉0.05）. There was no statistic difference between control group and trial group for the metastasis lymph nodes in difference dissection specimens. Parathyroid gland was found in 3 thy- roid or central compartment dissection specimens among trial group, which was found in 9 specimens among con- trol group, the difference had statistical significance （P〈0.05）. Conclusion：During levels I]I and IV dissection in cN0 patients or central compartment dissection, lymph nodes can be signed well by carbon nanoparticles, which can improve the lymph node detection rate, but can not increase the lymph node detection rate in cN＋ patients. Parathyroid gland can be preserved by carbon nanoparticles during the thyroid gland resection and central neck dissection.