纳米炭示踪剂在甲状腺乳头状癌手术的安全性和有效性

Safety and efficacy of carbon nanoparticles in operation for papillary thyroid carcinoma

目的 :研究纳米炭(carbon nanoparticle,CN)作为淋巴结示踪剂在有甲状腺手术史的甲状腺乳头状癌病人手术中的安全性和有效性。方法:回顾性分析53例有甲状腺手术史的甲状腺乳头状癌病人行甲状腺全切除+淋巴结清扫术的临床资料。27例术中使用CN(CN组),26例作为对照组。结果:CN组清扫的淋巴结数量明显高于对照组(P<0.01),但两组切除淋巴结转移的数量无统计学差异(P=0.077)。CN组清扫的240枚淋巴结中,176枚(73.33%)染成黑色,其中42枚(23.86%)有转移。病理检查结果显示,CN组3例发现甲状旁腺组织,对照组9例发现甲状旁腺组织(P=0.041)。CN组3例,对照组10例术后出现低钙血症(P=0.021)。两组病人术后声音嘶哑发生率无统计学差异(P=0.280)。结论:在有甲状腺手术史的甲状腺乳头状癌手术中,应用CN对病人有益处,保护甲状旁腺功能,维持病人术后血钙、磷代谢稳定。

Objective To evaluate the safety and clinical efficacy of carbon nanoparticles （CN） as a tracer in surgical operation for papillary thyroid carcinoma patients with a history of thyroid resection. Methods A retrospective analysis was performed using the clinical data of 53 cases with thyroid papillary carcinoma who had a history of thyroid resection re- ceiving total thyroidectomy combined with lymph node dissection. Twenty-seven cases had CN intra-operative treatment as CN group and 26 cases as control group without CN. Results The lymph node dissection was much more in CN group than in control group （P〈0.01）. However, there was no difference in the dissection of metastatic lymph node （P=0.077）. A total of 176 （73.33%） were stained black in 240 dissected lymph nodes of CN group, among which 42 （23.86%） lymph nodes were metastatic. Pathologic examination revealed that there were parathyroid in resection specimens from 3 cases in CN group compared with 9 cases in control group （P=0.041）. Three cases with hypocalcemia was found in CN group and 10 cases in control group on the postoperative day （P=0.021）. However, postoperative hoarseness had no statistical difference between CN group and control group （P=0.280）. Conclusions Using CN during the operation of papillary thyroid carcino- ma would be beneficial to the patients with history of thyroid resection reducing parathyroid injury and keeping serum cal- cium and phosphorus stable.