纳米碳示踪剂在甲状腺癌中央组淋巴结清扫中的应用及临床意义

摘要

目的:探讨纳米碳示踪剂在甲状腺癌中央组淋巴结清扫术中的应用及临床意义.方法:选取我院2015年1～12月收治的甲状腺癌患者60例为研究对象,随机分为2组,每组30例.在术中淋巴结清扫中使用纳米碳示踪剂的30例为淋巴结示踪组,未使用纳米碳示踪剂的30例为空白对照组.对2组清扫淋巴结数目、淋巴结阳性检出率、术后甲状旁腺功能等方面进行比较.结果:淋巴结示踪组淋巴结清扫总数高于空白对照组(269枚vs 204枚),平均淋巴结切除数多于空白对照组[(8.97±1.65)枚/例vs (6.8±1.52)枚/例)],差异有统计学意义(P＜0.05);淋巴结示踪组阳性淋巴结检出率高于空白对照组(40.15％vs 37.25％),平均阳性淋巴结切除数多于空白对照组[(3.6±1.16)枚/例vs (2.53±1.17)枚/例)],差异有统计学意义(P＜0.05).术后不良反应方面,淋巴结示踪组出现低钙血症、喉返神经损伤等临床表现的患者数均少于空白对照组.术后2d2组血钙水平均较基线值降低,且空白对照组血钙水平(2.173±0.20 mmol/L)与术前基线值(2.28±0.06 mmol/L)相比差异有统计学意义(P＜0.05);淋巴结示踪组术后2d血钙水平较空白对照组高(2.27±0.19 mmol/L vs 2.173±0.20 mmol/L),差异有统计学意义(P＜0.05).2组术后PTH水平均较基线值降低,而2组间PTH水平差异无统计学意义(P＞0.05).结论:术中使用纳米碳示踪剂提高了中央组淋巴结清扫的阳性率,并有助于识别甲状旁腺,减少术后不良反应.%Objective:to explore the effect of nano-carbon tracer on the dissection of central group lymph nodes in thyroid cancers.Methods:60 patients with thyroid cancers enrolled from January 2015 to December 2015 in our hospital were selected as research objects.Tracing group contained 30 cases would carry out nano-carbon tracer for the dissection of lymph nodes,while the other 30 patients without using nano-carbon tracer were defined as control group.The number of dissected lymph nodes,the discovery rate of positive lymph nodes and the postoperative parathyroid function were made a comparison between the two groups.Results:the total number of dissected lymph nodes in the tracing group was more than the control group (269 vs 204).The average number of dissected lymph nodes in the tracing group (8.97 ± 1.65/case) was also significantly more than the control group(6.8 ± 1.52/case)(P＜0.05).In the tracing group,the total discovery rate of positive lymph nodes was 40.15％,while the control group was 37.25％.Therefore,the average number of dissected positive lymph nodes in the tracing group (3.6 ± 1.16/case) was significantly more than the control group (2.53 ± 1.17/case)(P＜0.05).Observation of the postoperative adverse reactions,there were fewer patients suffering hypocalcemia or recurrent laryngeal nerve injury in the tracing group compared to the control group.In detail,although the blood calcium levels on the 2nd day after operation in both two groups decreased compared with preoperative baseline values,significantly statistical difference was only observed in the control group with 2.173 ±0.20mmol/L in postoperation vs 2.28 ± 0.06mmol/L in pre-operation (P＜0.05).What's more,the blood calcium level in the tracing group on the 2nd day after operation (2.27 ± 0.19mmol/L) was significantly higher than the control group (2.173 ± 0.20mmol/L)(P＜0.05).Besides,the postoperative PTH levels in both two groups reduced in some degree compared to the preoperative baseline values,but there were no statistical differences (P＞0.05).Conclusion:using nano-carbon tracer during the operation would be benefit for the dissection of positive central group lymph nodes,the recognition of parathyroid glands and reduction of postoperative adverse reactions.