吲哚菁绿联合纳米炭双示踪技术在腔镜甲状腺乳头状癌手术中的应用

目的:探讨吲哚菁绿（indocyanine green，ICG）联合纳米炭（carbon nanoparticles，CN）在腔镜甲状腺乳头状癌（papillary thyroid carcinoma，PTC）手术中的临床疗效。方法:将经胸乳入路行腔镜PTC手术的102例患者随机分为三组。单纯ICG组（n=33）术中显露甲状腺后于外周静脉注射ICG。根据静脉注射ICG正显影甲状旁腺，负显影淋巴结原理。在荧光腔镜系统下寻找荧光显影的甲状旁腺，并切除无荧光显影的中央区淋巴结。单纯CN组（n=32）术中显露甲状腺后于患侧腺体内注射CN混悬液。根据腺体内注射CN正显影淋巴结，负显影甲状旁腺原理。在腔镜下将黑染的中央区淋巴结和脂肪组织切除，保留负显影不染色的甲状旁腺。ICG+CN组（n=37），结合上述两组方法，利用双方的优势，双示踪、双识别，在腔镜下保留甲状旁腺，切除中央区淋巴结。比较三组患者的临床资料、手术相关指标、术后相关并发症等。结果:ICG+CN组较单纯ICG组及CN组在手术时间、清扫中央区淋巴结个数及中央区淋巴结转移个数方面表现更优，具有统计学差异（P＜0.05）；而ICG+CN组、单纯ICG组在暂时性甲状旁腺功能减退方面均优于单纯CN组，具有统计学差异（P＜0.05）。结论:通过外周静脉注射ICG和腺体内注射CN两者相结合的双示踪技术指导腔镜PTC手术，取得了较满意的临床疗效，还为临床实践提供了理论依据。

Application of the dual tracer technique of indocyanine green combined with carbon nanoparticles in endoscopic surgery for papillary thyroid carcinoma

Objective:To investigate the clinical efficacy of indocyanine green (ICG) combined with carbon nanoparticles (CN) in endoscopic surgery for papillary thyroid carcinoma (PTC).Methods:One hundred and two patients who underwent endoscopic surgery for PTC through the thoracic breast approach were randomly divided into three groups.In the ICG group (n=33),ICG was injected intravenously into the periphery after intraoperative visualization of the thyroid gland,and the principle of positive visualization of the parathyroid gland and negative visualization of the lymph nodes was followed.The fluorescence-visible parathyroid glands were searched for under a fluoroscopic lumpectomy system and the non-fluorescence-visible lymph nodes in the central region were removed.In the CN group (n=32),CN suspension was injected into the affected gland after intraoperative visualization of the thyroid gland.The lymph nodes were positively visualized and the parathyroid glands were negatively visualized according to the principle of intra-glandular injection of CN.The black-stained lymph nodes and adipose tissue in the central region were removed under lumpectomy,and the negative-stained parathyroid gland was preserved.In the ICG+CN group (n=37),the above two methods were combined to take advantage of both groups with double tracing and double identification,preserving the parathyroid glands and removing the lymph nodes in the central region under lumpectomy.The clinical data,surgery-related indexes,and postoperative-related complications of the three groups were compared.Results:The ICG+CN group performed better than the ICG group and the CN group in terms of operative time,number of cleared central lymph nodes and number of central lymph node metastases,with statistical differences (P＜0.05),while the ICG+CN group and ICG group were better than the CN group in terms of temporary hypoparathyroidism,with statistical differences (P＜0.05).Conclusion:The dual tracer technique combining intravenous ICG with intraglandular CN injection in endoscopic surgery for PTC can achieve more satisfactory clinical efficacy and provide a theoretical basis for clinical practice.