纳米碳负显影技术在甲状腺全切联合中央组淋巴结清扫术中的应用

摘要

Objective:To explore the effect of carbon nanoparticles as a lymphatic tracer on operation time,protection of parathyroid glands and lymph node desection during thyroid carcinoma surgery combined with lymphadenectomy.Methods:Two hundred and eighteen cases of thyroid carcinoma patients who accepted thyroidectomy combined with lymphadenectomy from March 2014 to March 2016 were anylized retrospectively.Patients were divided into carbon nanoparticles operation group(group C,95 cases)and routine operation group (group R,123 cases).Carbon nanoparticles lymphatic tracer was applied only in group C.Results:Average operation time was 85 min and 89 min in group C and group R,respectively.The numbers of frozen pathological section of uncertain parathyroid glands during operation were 1 and 9 in group C and group R,respectively.The numbers of parathyroid glands misresected were confirmed by pathology after surgery were 2 and 5 in group C and group R,respectively.Patients with hypocalcemia on the first day after surgery were 12 and 44 in group C and group R,respectively.There was a staticstically significant difference between the two groups (P＜0.05).Patients with low level of parathormone were 5 and 20 in group C and group R,respectively.The numbers of lymph nodesfrom central group lymphadenectomy were 1425 and 1107 in group C and group R,respectively.The difference between them was statistically different(P＜0.05).Conclusion:Carbon nanoparticles as a lymphatic tracer is important in protection and identification of parathyroid glands during total thyroidectomy combined with central group lymphadenectomy,it can help with the production of complete lymph node dissection and is worth popularizing and applying.%目的:探讨甲状腺全切联合中央组淋巴结清扫术中应用纳米碳负显影技术对手术时间、甲状旁腺保护和淋巴结清扫的影响.方法:回顾性分析2014年3月～2016年3月我院因甲状腺癌行甲状腺全切联合中央组淋巴结清扫术的218例患者的临床资料.将患者分为纳米碳组95例,术中应用纳米碳负显影技术,常规手术组123例,术中未应用纳米碳负显影技术.结果:纳米碳组和常规手术组手术时间平均为85±21min和89±19min.术中因不能明确是否甲状旁腺而行冰冻病理检查的甲状旁腺个数纳米碳组为1枚,常规手术组为9枚;术后d1低钙血症及甲状旁腺激素(PTH)降低的发生,组间差异均有统计学意义(均P＜0.05).2组均无永久性甲状旁腺功能低下的患者.中央组淋巴结清扫个数纳米碳组为1425枚,常规手术组为1107枚,差异有统计学意义(P＜0.05).结论:纳米碳负显影技术对甲状腺全切联合中央组淋巴结清扫术中甲状旁腺的辨识及保护有重要作用,并增加淋巴结清扫的彻底性,值得在甲状腺癌根治术中推广应用.