腔镜甲状腺癌手术中应用纳米碳对甲状旁腺功能保护的应用分析

The clinical application of carbon nanoparticles in protecting parathyroid function during endoscopic surgery of papillary thyroid cancer

目的 探讨腔镜甲状腺癌手术中应用纳米碳对甲状旁腺功能保护的经验。方法 2019年3月~2020年11月我院收治的甲状腺乳头状癌病人198例,分为开放组104例和腔镜组94例,术中均使用纳米碳。比较两组总体及不同分型间术中被识别出的甲状旁腺的识别数、误切数及行原位保留与自体移植的数量;比较两组术前、术后1天的血钙和甲状旁腺素水平。结果 两组中各分型间甲状旁腺识别数与误切数比较差异均无统计学意义(P>0.05),开放组总体数量多于腔镜组,差异有统计学意义(P<0.05);两组被识别出的A1型甲状旁腺行原位保留与自体移植数量比较,差异无统计学意义(P>0.05),A2型、B1型及总体间比较多于腔镜组,差异有统计学意义(P<0.05);两组术后1天血钙水平均与术前比较无明显变化(P>0.05),术后1天腔镜组甲状旁腺素水平低于开放组,且较术前有明显下降,差异有统计学意义(P<0.05)。结论 运用纳米碳混悬液负显影技术在甲状腺乳头状癌手术当中有效的保护甲状旁腺功能,但腔镜甲状腺癌手术中仍需注重注射方法以及精细化解剖操作。

Objective To explore the experience of parathyroid function protection during endoscopic surgery in papillary thyroid cancer.Methods The clinical data(the number of recognized and misdissected parathyroid glands;the number of preserved in situ and autotransplantated parathyroid glands;Caand PTH) of 198 patients with PTC were retrospectively analysed: open surgery was performed in 104 cases;endoscopic surgery was performed in 94 cases;all the cases used carbon nanoparticles during operation.Results No statistically significant difference was observed between the identification rates of type A1,A2,or B1,and the preservation in situ rates of type A1 in the two groups(P>0.05).Significant differences were found between the identification rates of type A2,B1 and total parathyroid glands, and the preservation in situ rates of type A2,B1,and total parathyroid glands in the 2 groups(P<0.05).There was no significant differences of the levels of Caand PTH before operation, and the levels of Caon postoperative day was found between the two group(P>0.05).The PTH level in endoscopic surgery was significantly lower than that in open surgery, and decreased significantly compared with that before surgery(P<0.05).Conclusion The negative development technique of carbon nanoparticles can effectively protect the parathyroid function during the operation of PTC,but surgeons should pay more attention to injection methods and accurate dissection.