纳米碳示踪剂在甲状腺微小乳头状癌手术中的应用

Clinical application of Carbon Nanoparticles in the Surgical Treatment of Papillary Thyroid Microcarcinoma

目的探讨纳米碳淋巴示踪剂在甲状腺微小乳头状癌中央区淋巴结清扫术中的应用价值。方法自2015年1月至2016年7月收治的40例单侧甲状腺微小乳头状癌患者被随机纳入对照组(20例)和纳米碳组(20例)。纳米碳组在患侧腺叶切除前给予纳米碳标记,手术均按患侧腺叶+峡部切除+患侧中央区淋巴结清扫术进行,由同一手术组医生完成。比较两组手术时间、术中出血量、术后引流液量,统计中央区淋巴结获取数目,误切甲状旁腺例数,术后低血钙发生率,喉返神经损伤率。计量资料采用(x珋±s)表示,采取t检验;术后并发症发生率采用百分率表示,结果采取χ2检验,数据分析采用SPSS 19.0软件。当P<0.05时认为结果具有统计学差异。结果在手术时间、术中出血量、术后引流液量方面,两组比较差异均无统计学意义(P>0.05)。纳米碳组术后中央区淋巴结获取数目显著多于对照组[(8±1.5)枚比(4±0.9)枚],P<0.05;误切甲状旁腺对照组5例(25%),纳米碳0例(0)。两组均无永久性喉返神经损伤及低钙血症发生,一过性低钙血症对照组3例(15%),纳米碳组0例(0)(P<0.05)。结论通过纳米碳混悬液进行术中淋巴结染色,可以显著增加中央区淋巴结清扫数目,并有助于辨认和保护甲状旁腺,降低淋巴结清扫可能带来的甲状旁腺误切除和术后低血钙发生。

Objective To investigate the clinical application of carbon nanoparticles in the surgical treatment of papillary thyroid microcarcinoma. Methods From Jan 2015 to July 2016,40 patients with unilateral papillary thyroid microcarcinoma who received surgical treatment were randomly divided into carbon nanoparticles group（ n = 20） and control group（ n = 20）,according to receiving carbon nanoparticles or not. 40 patients received the affected side thyroid lobe resection plus central compartment lymph node dissection,while all of surgery were performed by the same surgeon. Measurement data were represented as（ x^-± s） and were examined by using t test,including operation time,intraoperative blood loss,postoperative drainage,blood calcium,PTH,harvested lymph nodes and false resection of parathyroid gland. Incidence of postoperative hypocalcemia and RLN injury were compared by using χ^2 test. Statistical analysis were performed by using SPSS19. 0 software. A P value of〈 0. 05 was considered as significant difference.Results There were no significant difference between two groups in terms of operation time,intraoperative blood loss and postoperative drainage（ P〉0. 05）. However harvested central compartment lymph nodes in carbon nanoparticles group was significantly more than that in control group（ 8 ± 1. 5） vs（ 4 ± 0. 9）,P〈0. 05. There were 5 cases of false resection of parathyroid gland in control group,while no case（ 0） occurred in carbon nanoparticles group. There no permanent RLN injury and longterm postoperative hypocalcemia in both two groups,while 3 cases（ 15%） of short term hypocalcemia occurred in control group,which was higher than 0 in carbon nanoparticles group（ P〈0. 05）. Conclusions The lymphatic tracer technique by using carbon nanoparticles could improve the dissection of central compartment lymph node lymph nodes,while protecting parathyroid gland from false resection and decreasing the incidence of RLN injury and postoperative hypocalcemia.