纳米炭在甲状腺癌手术中对甲状旁腺及喉返神经的保护作用

Protective effect of Nanocarbon on parathyroid gland and recurrent laryngeal never in thyroid cancer surgery

目的探讨纳米炭在甲状腺癌手术中对甲状旁腺及喉返神经保护的应用价值。方法选取2016年10月至2018年8月于桂林医学院第二附属医院乳腺甲状腺外科行全甲状腺切除收治的甲状腺癌患者112例,随机均分为观察组和对照组。观察组注射纳米炭后行甲状腺全切及中央区淋巴结清扫,对照组未注射纳米炭,而直接手术。测量两组术前及术后第1、3和30天的血钙、甲状旁腺激素(PTH)水平,统计淋巴结清扫数量、淋巴结转移、甲状旁腺误切、暂时性低钙血症和永久性低钙血症及喉返神经损伤情况。结果两组患者术前及术后第30天的血钙、PTH水平比较差异均无统计学意义(P>0.05),观察组术后第1、3天的血钙、PTH水平均高于对照组(P<0.05)。观察组病理检出中央区淋巴结数量多于对照组(P<0.05),但两组淋巴结转移率差异无统计学意义(P>0.05)。观察组甲状旁腺误切率、术后暂时性低钙血症和永久性低钙血症的发生率以及喉返神经损伤率均低于对照组(P<0.05)。结论在甲状腺癌行全甲状腺切除及中央区淋巴结清扫术中应用纳米炭,可有效降低甲状旁腺误切及喉返神经损伤率,具有较高的临床应用价值。

Objective To explore the protective effect of nanocarbon on parathyroid and recurrent laryngeal never in thyroid cancer surgery.Methods A total of 112 patients with thyroid cancer who underwent total thyroidectomy in the department of breast and thyroid surgery of the Second Affiliated of Guilin Medical University from October 2016 to August 2018 were selected,they were randomly divided into observation group and control group.The observation group received total thyroidectomy and central lymph node dissection after injection of nanocarbon,the control group underwent direct surgery without nanocarbon.Serum calcium and parathyroid hormone(PTH)levels were measured preoperatively and 1 d,3 d and 30 d after surgery.Lymph node dissection,lymph node metastasis,parathyroid gland missection,temporary hypocalcemia and permanent hypocalcemia,and recurrent laryngeal nerve injury were counted.Results There were no statistically significant differences in serum calcium and PTH levels between the two groups preoperatively and 30 d after surgery(P>0.05),the levels of serum calcium and PTH in the observation group were all higher than those in the control group 1 d and 3 d after surgery(P<0.05).The number of central lymph nodes in the observation group was higher than that in the control group(P<0.05),but,there was no significant difference in lymph node metastasis rates between the two groups(P>0.05).The rate of parathyroid gland missection,the incidence of temporary hypocalcemia and permanent hypocalcemia,and the rate of recurrent laryngeal nerve injury in the observation group were all lower than those in the control group(P<0.05).Conclusions It is suggested from our present study that the application of nanocarbon in total thyroidectomy and central area lymph node dissection for thyroid cancer can effectively reduce the rate of parathyroid gland missection and recurrent laryngeal never injury,and it has high clinical application value.