纳米炭甲状旁腺负显影辨认保护技术在甲状腺手术中的应用研究

Application of Nano-carbon Negative Imaging Identification and Protection Technology of Parathyroid in Thyroid Surgery

目的探讨纳米炭甲状旁腺负显影辨认保护技术的应用对甲状腺全切除术时甲状旁腺的保护价值。方法方便选取该院2018年1月—2019年5月收治的30例疑似甲状腺恶性肿瘤患者,对30例甲状腺癌患者随机平均分为常规组和纳米炭组,比较两组术中辨认甲状旁腺的数目,自体移植甲状旁腺的数目,手术时间,术后第1天血钙、甲状旁腺激素水平,清扫淋巴结数目的情况。结果30例患者全部由同组手术者施行甲状腺全切和中央区淋巴结清扫术或功能性侧区颈部淋巴结清扫术。其中常规组术中辨认甲状旁腺数目共38枚,纳米炭组术中辨认甲状旁腺数目共50枚;常规组自体移植旁腺数目6枚,纳米炭组自体移植旁腺数目10枚;常规组手术时间(230.00±21.30)min,较纳米炭组手术时间(202.00±20.06)min长,差异有统计学意义(t=3.706,P<0.05);常规组术后第1天血钙(1.98±0.11)mmol/L,低于纳米炭组术后第1天血钙(2.15±0.13)mmol/L,差异有统计学意义(t=3.866,P<0.05);一过性低钙血症发生11例(73.33%),发生率高于纳米炭组1例(6.67%),差异有统计学意义(χ^(2)=13.889,P<0.05);常规组术后第1天甲状旁腺激素(1.48±0.25)pmol/L,低于纳米炭组术后第1天甲状旁腺激素(2.36±0.39)pmol/L,差异有统计学意义(t=7.357,P<0.05);甲状旁腺激素暂时性减低发生12例(80.00%),发生率高于纳米炭组2例(13.33%),差异有统计学意义(χ^(2)=13.393,P<0.05);常规组清扫淋巴结数目30/116枚,纳米炭组清扫淋巴结数目51/209枚。结论纳米负显影辨认保护技术的应用能够有助于对甲状腺癌切除和清扫手术患者的甲状旁腺进行保护,大大降低了甲状旁腺在手术过程中出现的损伤,对于患者的康复来说有积极意义。同时纳米碳易获得、使方便,安全高,无明显副作用,该方法在临床实际工作中易于掌握、安全性高。

Objective To explore the value of the application of nano-carbon negative imaging identification and protection technology for parathyroid glands during total thyroidectomy.Methods 30 patients with suspected thyroid malignant tumors admitted to the undergraduate room from January 2018 to May 2019 were selected.30 patients with thyroid cancer were randomly divided into the conventional group and the nanocarbon group,and the two groups were compared for the identification of parathyroid glands during the operation.The number of autologous transplanted parathyroid glands,operation time,blood calcium,parathyroid hormone levels on the first day after surgery,and the number of lymph nodes to be removed.Results All the 30 patients underwent total thyroidectomy,central lymph node dissection or functional lateral cervical lymph node dissection.Among them,38 parathyroid glands were identified intraoperatively in the conventional group and 50 were identified intraoperatively in the nanocarbon group.The number of para-glandular autologous transplantation was 6 in the conventional group and 10 in the carbon nanogroup.The operation time of the conventional group was(230.00±21.30)min,which was longer than that of the nanocarbon group(202.00±20.06)min,and the difference was statistically significant(t=3.706,P<0.05);the serum calcium of the conventional group was(1.98±0.11)mmol/L on the 1st day after surgery,which was lower than that of the nanocarbon group(2.15±0.13)mmol/L on the 1st day after surgery,and the difference was statistically significant(t=3.866,P<0.05));transient hypocalcemia was 11 cases(73.33%),higher than that of the nano canbon group 1 cases(6.67%),and the difference was statistically significant(χ^(2)=13.889,P<0.05);Parathyroid hormone(1.48±0.25)pmol/L in the conventional group on the 1st day after surgery,which was lower than that in the nano carbon group(2.36±0.39)pmol/L on the 1st day after surgery,and the difference was statistically significant(t=7.357,P<0.05);temporary reduction of parathyroid hormone occurred 12 cases(80.00%),which was higher than that of the nano carbon group 2 cases(13.33%),and the difference was statistically significant(χ^(2)=13.393,P<0.05);the number of lymph nodes dissected in the conventional group was 30/116,and that in the nano carbon group was 51/209.Conclusion The application of nano-negative imaging identification and protection technology can help to protect the parathyroid glands of patients undergoing thyroid cancer resection and dissection,greatly reducing the parathyroid gland damage during the operation,which is useful for the rehabilitation of patients.At the same time,nanocarbon is easy to obtain,convenient,safe,and has no obvious side effects.The method is easy to master and safe in clinical practice,and it is worthy of popularization in thyroid surgery.