纳米炭在cN0甲状腺癌预防性颈侧区淋巴结转移中的作用

Guiding role of nano-carbon in prevention of cervical lymph node dissection in cNO thyroid cancer

目的探讨纳米炭在甲状腺乳头状癌(papillary thyroid carcinoma,PTC)侧颈部淋巴结的示踪作用及对侧区淋巴结清扫策略的指导作用。方法回顾性分析2013年1月至2017年12月重庆医科大学附属第一医院内分泌乳腺外科516例PTC患者病历资料,其中cN0患者(436例),cN1患者(80例),男137例,女379例,男女比例1.00∶2.76。在术中应用纳米炭示踪淋巴结,收集各个侧区(Ⅱ区、Ⅲ区、Ⅳ区)淋巴结数目,根据术后病理结果计算黑染及非黑染淋巴结转移(lymph node metastasis,LNM)率。应用SPSS 22.0统计软件进行分析,计量资料采用t检验,计数资料采用χ2检验。结果 436例cN0患者黑染LNM率Ⅱ区(P=0.002)、Ⅲ区(P=0.000)、Ⅳ区(P=0.002)均高于非黑染LNM。80例cN1患者(Ⅱ、Ⅲ、Ⅳ)区黑染LNM率同样高于非黑染LNM(0.011、0.019、0.015),cN0患者Ⅲ区黑染LNM率影响Ⅱ区、Ⅳ区LNM(P=0.000、P=0.000)。cN1患者Ⅲ区黑染LNM率对Ⅱ区有影响(0.030),对Ⅳ区黑染LNM率无影响(0.315)。结论使用纳米炭后侧区(Ⅱ区、Ⅲ区、Ⅳ区)黑染LNM率能代表侧区LNM率,有助于指导侧区淋巴结清扫;另Ⅲ区黑染LNM率可影响Ⅱ区、Ⅳ区LNM率,有侧区前哨淋巴结的作用。

Objective To explore the tracing effect of nano-carbon in the cervical lymph nodes of papillary thyroid carcinoma(PTC)and the guiding role of the dissection strategy of the contralateral lymph nodes.Methods The medical records of 516 patients with PTC in Department of Endocrine and Breast Surgery,the First Affiliated Hospital of Chongqing Medical University from Jan.2013 to Dec.2017,including cNO patients(436 cases)and cN1 patients(80 cases),were retrospectively analyzed.There were 137 males and 379 females,the male to female ratio was 1.00:2.76.During the operation,nano-carbon was used to trace lymph nodes,and the number of lymph nodes in each lateral area(area Ⅱ,Ⅲ,Ⅳ)was collected,and the rate of black stained and nonblack stained lymph node metastasis(LNM)was calculated based on the postoperative pathological results.SPSS 22.0 statistical software was used for analysis,t test was used for measurement data,and#test was used for count data.Results In 436 patients with cNO,the black-stained LNM rate in zone Ⅱ(P=0.002),the black-stained LNM rate in zone Ⅲ(P=0.000),and the black-stained LNM rate in zone Ⅳ(P=0.002)were higher than those of nonblack stained LNM.The rate of black-stained LNM in 80 cN1 patients(Ⅱ,Ⅲ,Ⅳ)was also higher than that of nonblack-stained LNM(0.011,0.019,0.015).The rate of black-stained LNM in cNO patients affected the LNM in areas Ⅱ and Ⅳ(P=0.000,P=0.000).In patients with cN1,the black-stained LNM rate in zone DI had an effect on zone Ⅱ(0.030);it had no effect on the black-stained LNM rate in zone Ⅳ(0.315).Conclusion The black-stained LNM rate of the posterior zone(zone Ⅱ,Ⅲ,Ⅳ)with nano-carbon can represent the LNM rate of the lateral zone and help guide the lymph node dissection in the lateral zone.In addition,the black-stained LNM rate of zone Ⅲ can affect zone H.The LNM rate in zone Ⅳ has the role of sentinel lymph nodes in the lateral zone.