纳米炭在甲状腺全切除联合中央区淋巴结清扫中的应用价值

The value of carbon nanoparticles in total thyroidectomy combined with central lymph node dissection

目的探讨纳米炭在甲状腺乳头状癌（papillary thyroid careinoma，PTC）行甲状腺全切除联合中央区淋巴结清扫中的应用价值。方法回顾性分析东南大学医学院附属江阴医院甲乳外科手术43例单侧PTC患者，手术方式为甲状腺全切除联合患侧中央区淋巴结清扫，据术中是否使用纳米炭混悬液，分为纳米炭组和对照组。比较2组手术时间、术后住院时间；术后第1天的血清钙、甲状旁腺激素及其变化比率；中央区清扫的淋巴结数目及其转移率；术后并发症情况。结果2组手术时间差异无统计学意义（P〉0．05），纳米炭组术后住院时间比对照组短（P〈O．05）；纳米炭组术后第1天的血清钙（2．31±0．13）mmol／L、甲状旁腺激素（33．45±14．37）pg／ml均高于对照组（P〈0．05），低血钙发生率15％（3／20）、暂时性甲状旁腺功能减退发生率10％（2／20）及甲状旁腺激素的下降幅度（47．3％±14．31％）均低于对照组（P〈0．05）；纳米炭组清扫的中央区淋巴结个数（9．45±2．33）枚／例多于对照组（P〈0．05），其中右侧喉返神经后的淋巴结个数（3．12±0．65）枚／例也明显多于对照组（P〈0．05），2组淋巴结的转移率相比较差异无统计学意义（P〉0．05）；纳米炭组的术后并发症发生率明显低于对照组（P〈0．05）。结论甲状腺全切除联合中央区淋巴结清扫中使用纳米炭，有助于识别和保护甲状旁腺及其血供，提高中央区淋巴结清扫的彻底性，同时降低了术后并发症的发生率。

Objective To explore the value of carbon nanoparticles in patients with papillary thyroid carcinoma（PTC） undergoing total thyroidectomy combined with ipsilateral central lymph node dissection. Methods 43 patients with unilateral PTC were retrospectively analyzed. All patients underwent total thyroidectomy combined with central lymph node dissection. Patients were divided into carbon nanoparticles group and the control group according to whether carbon nanoparticles were used in the operation. The operation time, postoperative hospitalization time, the serum calcium level and its rate of change, the parathyroid hormone and its rate of change on the 1st day after surgery, the number of central lymph node and the transfer rate, and the postoperative complications were compared between the 2 groups. Results There was no statistical difference between the 2 groups in operation time （P 〉 0. 05 ） ,while the postoperative hospitalization time of the carbon nanoparticles group was shorter than that of the control group（ P 〈 0. 05 ）. The serum calcium and the parathyroid hormone on the 1st day after surgery in the carbon nanoparticles group was （ 2. 31 ±0. 13 ） mmol/L and （ 33.45 ±14. 37 ） pg/ml respectively, higher than those of the control group （ P 〈 0. 05 ）. The low blood calcium rate （ 3/20 （ 15% ） ）, the temporary hypoparathyroidism rate （ 2/20 （ 10% ） ） and the decline degree of parathyroid hormone （ 47.3 ± 14. 31 ） % in the carbon nanoparticles group were lower than those of the control group （ P 〈 0. 05 ）. The number of central lymph node dissected （9.45 ± 2. 33 ）pieces/case in the carbon nanoparticles group was more than that of the control group（P 〈0.05）. The number of lymph node in the right recurrent laryngeal nerve（3.12 ±0. 65） pieces/case was more than that of the control group（P 〈0. 05 ）. The lymph node metastasis rate had no significant difference between the 2 groups（ P 〉 0.05 ）. The incidence of postoperative complications in the carbon nan- oparticles group was lower than that of the control group （ P 〈 0. 05 ）. Conclusion The application of carbon nanoparticles in total thyroidectomy combined with central lymph node dissection can contribute to the recognition and protection of parathyroid glands and its blood supply, improve the rate of central lymph node dissection, and reduce the incidence of postop-erative complications.