纳米碳示踪前哨淋巴结在cNO分化型甲状腺癌中的应用

摘要

目的 探讨纳米碳示踪前哨淋巴结在cNO分化型甲状腺癌中的作用.方法 2013年1月-2016年12月,威海市市立医院共收治cNO分化型甲状腺癌患者52例,病理类型均为甲状腺乳头状癌,临床颈淋巴结阴性.用纳米碳混悬液对52例甲状腺乳头状癌患者行前哨淋巴结定位活检.将前哨淋巴结病理情况与病理结果对比.定位前哨淋巴结的位置和计数前哨淋巴结的数量,对哨淋巴结的成功检出率、前哨淋巴结与常规病理淋巴结转移的符合率、前哨淋巴结的假阴性与假阳性率进行计算,观察患者的手术并发症.结果 本组52例患者中,发现染色显黑染的SLN 49例,检出率为94.23％％(49/52).SLN染色时间平均为(7.2士23.1)min,共检出SLE 114枚,平均每例患者检出淋巴结2.33枚.不同位置各组淋巴结在检出率差异有统计学意义(x2=14.388,P=0.006).位于Ⅳ区和Ⅵ区的淋巴结检出率为86.84％.检出的114枚淋巴结,有转移的SLN 69枚(60.53％).各区域SLE转移阳性率经比较差异有统计学意义(x2=13.232,P=0.010),其中Ⅵ区和Ⅳ区SLN转移阳性率明显高于其它区域的淋巴结的检出率,差异有统计学意义(x2 =11.874,P=0.001),淋巴管显影36例(69.23％),染色剂外渗3例(5.77％),甲状旁腺染色2例(3.85％),喉返神经染色1例(1.89％).SLN检测准确率为96.15％(50/52),SLN检测的敏感度为93.11％(27/29),假阴性率为6.90％(2/29).结论 对于颈部淋巴结阴性的甲状腺乳头状癌,前哨淋巴结状况能反映转移状况,纳米活性碳对甲状腺癌患者进行示踪增加淋巴结清除率,降低甲状旁腺和喉返神经损伤机率.%Objective To investigate the role of nanoprobe in sentinel lymph node (SLN) in cNO differentiated thyroid carcinoma.Methods 52 patients with cNO differentiated thyroid carcinoma in Weihai Wei People's Hospital from January 2013 to December 2016 were enrolled in this study.All pathological types were thyroid papillary carcinoma and negative clinical cervical lymph node.Pathological analysis of sentinel lymph nodes with the last paraffin pathology was compared.The location and number of sentinel lymph nodes,the detection rate of sentinel lymph nodes,the coincidence rate of sentinel lymph nodes and conventional pathologic lymph node metastasis were detected.The false negative and false positive rates of sentinel lymph nodes and surgical complications were calculated.Results In 52 patients,49 cases of SLN stained with dark staining were found,the detection rate was 94.23％ (49/52).SLN staining time was (7.2 ±23.1) min,a total of SLE were detected out by 114,and the average number of detected lymph node was 2.33.There were significant differences in the detection rate of lymph nodes in different locations (x2=14.388,P =0.006).According to the lymph node division method,the detection rate of lymph nodes in area Ⅳ and Ⅵ was 86.84％,which was significantly higher than that of other areas.In 114 lymph nodes,metastatic SLN were 69 (60.53％).The positive rate of SIR metastasis in each region was statistically significant (x2 =13.232,P =0.010).The positive rate of SLN metastasis in area Ⅵ and Ⅳ was significantly higher than that in other regions (6.9％),and there were 3 cases (5.77％) of extravasation of the stain,2 cases (3.85％) of parathyroid gland,and 1 case of recurrent laryngeal nerve (1.89％).The rate of SLN was 96.15％ (50/52),and the sensitivity of SLN was 93.11％ (27/29).There were 52 patients with SLN,22 patients with SLN,and 22 with SLN.The false negative rate was 6.90％ (2/29).Conclusion Sentinel lymph node status can reflect the lymph node metastasis situation of papillary carcinoma with lymph nodenegative thyroid.The activity of lymph node dissection and the incidence of parathyroid and recurrent laryngeal nerve injury were reduced by the activity of nano-activated carbon in patients with thyroid cancer.