纳米碳在双甲全切加双侧中央区淋巴结清扫术中的临床应用

Clinical application of carbon nanoparficles in patients with thyroid carcinoma undergoing total thy- roidectomy plus bilateral central neck dissection

目的探讨纳米碳示踪剂在分化型甲状腺癌行甲状腺全切加双侧中央组淋巴结清扫中对淋巴结的清扫及甲状旁腺的保护作用。方法将2015年9月至2016年2月上海交通大学医学院附属瑞金医院普外科初治的，行甲状腺全切＋双侧中央组淋巴结清扫手术的100例TC患者采用随机数字表法分为纳米碳组与对照组。统计2组淋巴结清扫总数、右侧RLN后方淋巴结清扫数、淋巴结转移数、甲状旁腺病理检获及术后甲状旁腺激素（parathyroid hormone,PTH）及血钙水平。结果纳米碳组平均每例清扫淋巴结数为（10.96±5.43）枚，高于对照组（8.22±4.40）枚，2组差异有统计学意义（t=2.78，P=0.01），其中纳米碳组平均每例RLN后方淋巴结清扫数为（1.62±1.95）枚，高于对照组（0.76±1.21）枚，2组差异有统计学意义（t=2.66,P=0.01）。纳米碳组转移淋巴结数为（2.02±2.40）枚，对照组转移淋巴结数为（1.84±2.61）枚，2组间差异无统计学意义（t=0.36，P〉0.05），纳米碳组与对照组术后第1天甲状旁腺素测量值及甲状旁腺激素下降值差异均无统计学意义（t=0.23，P〉0.05；t=1.04,P〉0.05）。甲状旁腺误切率纳米碳组为2%（1/50），对照组为6%（3/50），差异无统计学意义（χ2=0.26，P〉0.05）。结论活性纳米碳在TC手术中有利于中央区淋巴结的彻底清扫，但对术中甲状旁腺的功能保护可能更加依赖于术者的经验及血供的保护。

ObjectiveTo evaluate the role of cabon nanoparticles for dissecting lymph nodes and preserving parathyroid glans in patients with differentiated thyroid carcinoma undergoing total thyroidectomy plus bilateral central neck dissection.MethedsFrom Sep. 2015 to Feb. 2016, 100 patients in Rui Jin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine with thyroid carcinoma undergoing primarily total thyroidectomy plus bilateral central neck dissection were randomly divided into carbon nonoparticle group and the contol group. The numbers of total dissected lymph nodes, the lymph node posterior to fight recurrent laryngeal nerve, metastasized lymph nodes, inadvertent parathyroidectomy, the parathyroid hormone and serum total calcium were measured.ResultsThe average counts of lymph nodes in carbon nonoparticle group （10.96±5.43） were more than those in the control group at （8.22±4.40） lymph nodes, （t=2.78, P=0.01） . The average counts of lymph node posterior to fight recurrent laryngeal nerve in carbon nonoparticle group （1.62±1.95） were more than those in the control group at （0.76±1.21） lymph nodes, （t=2.66, P=0.01） . The numbers of metastasized lymph nodes was 2.02±2.40 in carbon nonoparticle group and 1.84±2.61 in the control group. The difference had no statistical significance （t=0.36, P〉0.05） . The amount of PTH and the decrease of PTH discrepancy one day after surgery between the two groups had no statistical difference （t=0.23, P〉0.05） , （t=1.04, P〉0.05） . The carbon nonoparticle group had 2% （1/50） mistakenly parathyroid gland removed incidence, on contrary, the control group had 6% （3/50） mistakenly removed incidence. The difference had no statistical significance （χ2=0.26, P〉0.05） .ConclusionCarbon nonoparticle can improve the central lymph node detection rate, but the protection of the parathyroid glands is more likey to depend on the experience of the operator and the vascular protection.