甲状腺癌再次手术时纳米碳引导下的精准淋巴结清扫

Precise Dissection of Lymph Node Guided by Carbon Nanoparticles in Reoperation for Thyroid Cancer Recurrence

目的探讨纳米碳染色在甲状腺癌复发再次手术淋巴结清扫中的效果。方法纳入2015年7～11月于四川大学华西医院甲状腺和甲状旁腺外科诊断为甲状腺癌术后复发患者作为研究对象,在再次手术之前行超声引导下纳米碳注射淋巴结染色,并对染色情况及手术情况进行分析。结果本研究共纳入22例甲状腺癌术后复发患者,手术时间（60.45±12.91）min。总共清扫淋巴结405枚,7～34枚/例,平均18.4枚/例;黑染率为71.9%（291/405）。术后病理学检查结果显示,纳米碳黑染淋巴结阳性率为45.0%（131/291）,非黑染淋巴结阳性率为5.3%（6/114）,差异有统计学意义（P〈0.001）。非目标淋巴结中,纳米碳黑染和未被黑染的淋巴结阳性率分别为30.2%（62/205）和5.3%（6/114）,差异有统计学意义（P〈0.001）。结论 ＂纳米碳引导下淋巴结精准清扫＂可有效提高对不可触及淋巴结转移灶的清除率,值得在临床上推广。

Objective To investigate the value of carbon nanoparticle adopted in reoperation for thyroid cancer recurrence. Methods From July to November of 2015, patients diagnosed with thyroid cancer recurrence in department of Thyroid ＆ Parathyroid surgery, West China Hospital, Sichuan University were enrolled in the research. All enrollment patients underwent carbon nanoparticles location guided by uhrasonography before reoperation. Relative data about surgery and location were analyzed retrospectively. Results Twenty-two patients were enrolled in the research. Mean operation time was （60.45±12.91） minutes. During surgery, a total of 405 （average 18.4） lymph nodes were harvested, and the staining rate was 71.9% （291/405）. The pathological examination showed that there was a significant difference in the positive rate between carbon nanoparticles stained lymph nodes （45.0%, 131/291） and non-stained lymph nodes （5.3%, 6/114）, P〈0.001. In addition, the positive rate in non-targeted stained lymph nodes was 30.2% （62/205）. By contrast, it was 5.3% （6/114） in non-targeted non-stained lymph nodes. The difference showed significant significance （P〈0.001）. Conclusions Adoption of carbon nanoparticles in reoperation for thyroid cancer, which improves efficiency of dissection for the non-palpable lymph nodes metastasis, is worth generalizing in clinical oractice.