纳米炭在甲状腺手术中使用方法的全国百名专家10年经验问卷调查报告

Utilization of carbon nanoparticles in thyroid surgery:a questionnaire survey based on the 10-year experience of 100 experts nationwide

背景与目的:纳米炭混悬注射液(以下简称纳米炭)作为一种淋巴结示踪剂,已广泛应用于甲状腺手术中快速识别甲状旁腺,避免手术误伤。然而,目前甲状腺乳头状癌(PTC)手术中的纳米炭具体使用方法、标准技术流程尚未统一。因此,本研究通过问卷调查的方式了解国内外科医师在PTC手术中使用纳米炭的技巧、体会和经验,以期为临床规范化使用纳米炭提供依据。方法:在文献调研的基础上,设计“纳米炭在甲状腺乳头状癌中的使用方法”专家调查问卷表,分发给从事甲状腺外科的高年资、高手术量的外科医师填写,回收问卷后进行统计分析。结果:本次调研共发放问卷107份,返回的有效问卷共计105份,来自26省78家三级甲等医院。91位(86.7%)专家每年使用纳米炭数量在100~1000支。调查的专家意见协调程度较高,53位(50.5%)专家认为注射纳米炭后甲状腺腺叶呈现地图样斑驳均匀染色为最佳,在甲状腺腺叶切除和全部切除术中,超过90%的专家认为术中注射纳米炭为最佳时机,超过50%的专家认为纳米炭每点注射最佳剂量为0.05~0.1 mL,注射后需等待1~5 min;腺叶切除只需注射1个位点,全切只需要注射2个位点;注射后1~5 min甲状旁腺负显影和中央区淋巴结染色。超过70%的专家推荐在颈侧方淋巴结清扫、腔镜和机器人甲状腺手术中采用术中直视下纳米炭注射。总结避免术中纳米炭渗漏的应用技巧包括:适当稀释、细针刺入、包膜完整、少量注射、把控深度、负压拔针、常规压迫、凝闭针孔、术野清洁。结论:本研究首次通过问卷调查的方式初步了解外科医师使用纳米炭的情况,为纳米炭使用的技术方法做出了经验性的总结与归纳,调查结果具有较好的代表性,为以后纳米炭合理、正确地使用与临床应用研究提供了指导基础。

Background and Aims:Carbon nanoparticles suspension injection(hereinafter referred to as carbon nanoparticles),as a lymph node tracer,has been widely used in thyroid surgery to quickly identify parathyroid glands and avoid inadvertent surgical damage.However,the specific usage methods and standardized technical procedures for carbon nanoparticles in surgery for thyroid papillary carcinoma(PTC)are not yet unified.Therefore,this study was conducted to gather the skills,knowledge,and experiences of domestic surgeons regarding the use of carbon nanoparticles in surgery for PTC through a questionnaire survey,so as to provide a basis for the standardized clinical use of carbon nanoparticles.Methods:On the basis of literature review,a questionnaire survey titled Methods of utilizing carbon nanoparticles in thyroid papillary carcinoma was designed and distributed to senior and high-volume surgeons engaged in thyroid surgery.After the questionnaires were collected,a synthetic analysis was conducted.Results:A total of 107 questionnaires were distributed in this survey,and 105 valid responses were received from 78 tertiary grade A hospitals in 26 provinces.Among the experts surveyed,91(86.7%)reported using carbon nanoparticles at a quantity ranging from 100 to 1000 vials annually.There was a high degree of consensus among the experts,with 53(50.5%)considering the thyroid gland showing a map-like,mottled,and evenly stained appearance as the best result after injection of carbon nanoparticles.In lobectomy and total thyroidectomy,over 90% of experts believed that intraoperative injection of carbon nanoparticles was the optimal timing.More than 50% of experts suggested an optimal injection dose of 0.05 to 0.1 mL per injection point,with a waiting time of 1 to 5 min after injection,believed that only one injection point was needed for lobectomy,while two injection points were deemed sufficient for total thyroidectomy,and found that the time for negative imaging of the parathyroid glands and central lymph node staining was 1 to 5 min after injection.Over 70% of experts recommended the intraoperative direct visualization injection of carbon nanoparticles in lateral neck lymph node dissection,endoscopic,and robotic thyroid surgeries.The summary of techniques to avoid intraoperative leakage of the tracer included appropriate dilution,fine needle insertion,intact capsule,minimal injection volume,depth control,negative pressure needle extraction,routine compression,sealing the needle track,and maintaining a clean surgical field.Conclusion:This study,for the first time,provides an initial understanding of the usage of carbon nanoparticles among surgeons through a questionnaire survey.It offers an experiential summary and generalization of the technical methods employed with carbon nanoparticles.The survey results demonstrate good representativeness,serving as a guiding foundation for future research on the rational and correct use of nano-carbon in in clinical settings.