纳米碳示踪技术在改良Miccoli甲状腺手术中的应用效果观察

Application of carbon nanoparticles in modified Miccoli thyroid surgery

目的观察纳米碳示踪技术在改良Miccoli甲状腺手术中对淋巴结清扫、甲状旁腺与喉返神经保护的应用效果。方法选取行甲状腺手术的患者360例,其中180例行常规喉返神经监测下的改良Miccoli甲状腺手术+纳米碳示踪技术为实验组;另180例行常规喉返神经监测下的改良Miccoli甲状腺手术为对照组。观察两组患者淋巴结清扫总数,实验组患者黑染淋巴结清扫总数;比较两组患者淋巴结清扫数,甲状旁腺误切率,术前、术后6h及1d血钙、甲状旁腺素水平,喉返神经损伤发生率,手术时间,术中出血量,术后引流量,术后住院时间;比较两组各种病理类型患者平均淋巴结清扫数、甲状旁腺误切率、手术前后血钙、甲状旁腺素水平。结果实验组患者术中淋巴结清扫总数为413枚,对照组为290枚。实验组黑染淋巴结清扫总数为373枚,占90.31%。与对照组比较,实验组患者术中淋巴结清扫数较多、甲状旁腺误切率较低(均P<0.05)。术后6h与术后1d,实验组患者血钙、甲状旁腺素水平均高于对照组(均P<0.05)。实验组患者手术时间长于对照组(P<0.05)。两组患者喉返神经损伤发生率、术中出血量、术后引流量、术后住院时间比较差异均无统计学意义(均P>0.05)。病理类型为乳头状癌、微小乳头状癌、滤泡状癌的实验组患者平均淋巴结清扫数多于对照组(均P<0.05)。病理类型为微小乳头状癌、淋巴细胞性甲状腺炎、巨大良性甲状腺肿物的实验组患者甲状旁腺误切率低于对照组(均P<0.05)。病理类型为乳头状癌、微小乳头状癌、滤泡状癌、甲状腺腺瘤、结节性甲状腺肿的实验组患者术后6h与术后1d血钙、甲状旁腺素水平均高于对照组(均P<0.05)。结论纳米碳示踪技术在改良Miccoli甲状腺手术中的应用效果确切,可提高淋巴结清扫的彻底性,还有助于避免损伤甲状旁腺,从而有效保护甲状旁腺功能,但对喉返神经的保护效果不明显,且在不同病理类型患者的手术中效果有差异。

Objective To assess the application of carbon nanoparticles in modified Miccoli thyroid surgery. Methods Three hundred patients underwent modified Miccoli surgery for thyroidectomy with routine recurrent laryngeal nerve monitoring.The carbon nanoparticle tracing technique was applied in 180 cases(study group)and not used in the remaining 180 cases(control group).The number of lymph node dissected,misresection rate of parathyroid,serum calcium and parathyroid hormone levels before and 6 h,1d after surgery,incidence of recurrent laryngeal nerve injury,operative time,intraoperative blood loss,postoperative drainage,postoperative hospital stay were compared between two groups.The number of lymph node dissected,misresection rate of parathyroid glands,and serum calcium and parathyroid hormone levels before and after surgery were also compared among different pathological types in two groups. Results The total number of lymph node dissected was 413 in study group and 290 in the control group.The number of carbon-stained lymph nodes in the study group was 373,accounting for 90.31%of all lymph nodes dissected.Compared with the control group,the number of intraoperative lymph node dissected and the misresection rate of parathyroid glands were lower in the study group(P<0.05).The serum calcium and parathyroid hormone levels in the study group were higher than those in the control group at 6h and 1d after surgery(P<0.05).The duration of surgery in the study group was longer than that in the control group(P<0.05).There was no significant difference in the incidence of recurrent laryngeal nerve injury,intraoperative blood loss,postoperative drainage,and postoperative hospital stay between the two groups(P>0.05).The number of lymph node dissected in the study group with pathological types of papillary,micropapillary,and follicular carcinoma was more than that in the control group(P<0.05).The misresection rate of parathyroid gland in the study group with pathological types of micropapillary carcinoma,lymphocytic thyroiditis,and huge benign thyroid mass was lower than that in the control group(P<0.05).The serumlevels of calcium and parathyroid hormone in study group with pathological types of papillary,micropapillary and follicular carcinoma,thyroid adenoma and nodular goiter were significantly higher than those of in control group at 6h and 1d after surgery(P<0.05).Conclusion The application of carbon nanoparticle tracing technique in the modified Miccoli thyroid surgery can improve lymph node dissection,and avoid parathyroid gland damage.However,its protective effect on the recurrent laryngeal nerve is not significant,and the effect varies for different pathological types of thyroid diseases.