术前超声引导下注射纳米炭在cN 0期甲状腺乳头状癌根治手术中的应用分析

Analysis of the application of preoperative ultrasound-guided injection of carbon nanoparticles in radical treatment of stage cN 0 papillary thyroid carcinoma

目的观察术前应用纳米炭混悬注射液在cN 0甲状腺乳头状癌患者根治性手术中对中央区淋巴结清扫的效果的影响及评估其在甲状旁腺功能保护中的作用。方法选取广西医科大学附属肿瘤医院头颈外科2021年9月至2023年6月收治的cN 0期甲状腺乳头状癌患者104例,随机分为观察组和对照组各52例,观察组于术前1 d在原发肿瘤周围注射纳米炭混悬注射液0.2 ml,对照组不注射。两组患者均行单侧甲状腺切除术+中央区淋巴结清扫术,依据手术入路的不同,进一步将观察组分为开放观察组(26例)、腔镜观察组(26例),同样将对照组分为开放对照组(26例)、腔镜对照组(26例)。比较各组的手术时间、术中出血量、住院时间、检出淋巴结数量、阳性淋巴结数量及甲状旁腺误切率等。结果104例甲状腺切除患者术后发生甲状旁腺误切14例(13.46%),观察组甲状旁腺误切率显著低于对照组(P<0.05)。观察组检出淋巴结数量及阳性淋巴结数量均显著多于对照组(P<0.05)。观察组与对照组患者手术时间、术中出血量、住院时间比较差异无统计学意义(P>0.05)。亚组分析中,腔镜观察组较腔镜对照组甲状旁腺误切率低,差异有统计学意义(P<0.05)。结论术前应用纳米炭混悬注射液在cN 0期甲状腺乳头状癌根治性手术中可提高淋巴结检出数量,降低甲状旁腺误切率,在经腋窝腔镜甲状腺癌根治手术中对甲状旁腺功能保护作用显著。

Objective To observe the effect of preoperative application of carbon nanoparticles suspension injection on central lymph node dissection in patients with cN 0 papillary thyroid carcinoma who underwent radical surgery and to evaluate its role in protecting parathyroid function.Methods A total of 104 patients with stage cN 0 papillary thyroid carcinoma who were admitted to the Department of Head and Neck Surgery of Guangxi Medical University Cancer Hospital from September 2021 to June 2023 were selected and randomly divided into observation group and control group,with 52 cases in each group.The observation group was injected with 0.2 ml carbon nanoparticles suspension injection around the primary tumor 1 day before surgery,while the control group was not injected with carbon nanoparticles suspension injection.The patients in both groups underwent unilateral thyroidectomy+central lymph node dissection.According to different surgical approaches,the observation group was further divided into open surgery observation group(26 cases)and endoscopic surgery observation group(26 cases),and the control group was also divided into open surgery control group(26 cases)and endoscopic surgery control group(26 cases).The operation time,intraoperative blood loss,hospital stay,the number of lymph nodes detected,the number of positive lymph nodes and the rate of mis-dissected parathyroid glands were compared between the two observation groups and between the two control groups.Results There were 14 cases(13.46%)of the 104 patients with mis-dissected parathyroid glands after thyroidectomy.The rate of mis-dissected parathyroid glands in the observation group was lower than that in the control group(P<0.05).The number of lymph nodes detected and the number of positive lymph nodes in the observation group were higher than those in the control group(P<0.05).There were no significant differences in operation time,intraoperative blood loss and hospital stay between the observation group and the control group(P>0.05).In the subgroup analysis,the rate of mis-dissected parathyroid glands in the endoscopic surgery observation group was lower than that in the endoscopic surgery control group,and the difference was statistically significant(P<0.05).Conclusion The preoperative application of carbon nanoparticles suspension injection can increase the number of lymph nodes detected and reduce the rate of mis-dissected parathyroid glands in the radical surgery of stage cN 0 papillary thyroid cancer,and has a significant protective effect on parathyroid function in radical surgery of transaxillary endoscopic thyroidectomy for thyroid carcinoma.