纳米碳示踪前哨淋巴结在cNO分化型甲状腺癌术中的应用

目的 探讨前哨淋巴结活检在cN0分化型甲状腺癌术中的应用价值.方法 回顾性分析青岛市妇女儿童医院乳腺甲状腺科2012年1月-2013年1月行手术治疗的106例cN0分化型甲状腺癌患者的临床资料.术中用纳米碳示踪前哨淋巴结,根据快速冰冻结果决定是否行中央区淋巴结清扫,清扫组46例(包括2例前哨淋巴结未检出者),未清扫组60例.比较两组的手术相关指标、并发症发生情况和短期疗效.结果 前哨淋巴结清扫组的手术时间、术中出血量、甲状旁腺误切率均高于未清扫组,两组比较差异有统计学意义(P＜0.05);清扫组暂时性甲状旁腺功能减退的发病率高于未清扫组,两组对比差异有统计学意义(P＜0.05),两组患者均未发生永久性的甲状旁腺功能减退和喉返神经损伤;术后门诊随访30个月,清扫组和未清扫组的局部复发率分别为6.5％ (3/46)和10％(6/60),差异无统计学意义(P＞0.05),两组均无远处转移.结论 前哨淋巴结活检能发现早期转移的颈部淋巴结,对决定是否行中央区淋巴结清扫起到了指导作用;纳米碳淋巴示踪剂安全可靠,有助于甲状旁腺的保护.

Application of carbon nanoparticles tracer sentinel lymph node in the operation of clinical stage NO differentiated thyroid carcinoma

Objective To evaluate the application of sentinel lymph node biopsy in surgical operation for clinical stage N0 differentiated thyroid carcinoma.Methods One hundred and six patients who were diagnosed clinical stage N0 differentiated thyroid carcinoma in Department of Mammary Gland Thyroid Surgery of Qingdao Women and Children's Hospital between Jan.2012 and Jan.2013 were reviewed retrospectively.Carbon nanoparticles were used to trace sentinel lymph node in the surgery,the patients were divided into the dissection group (46 cases included 2 cases whose sentinel lymph nodes were not detected) and the non dissection group (60 cases) based on the rapid pathological results.The operation index,complications incidence and short-term outcomes were compared.Result The operative time,intraoperative blood loss and the faulty excision of parathyroid gland in dissection group is much higher than those in non dissection group (P ＜0.05).The incidence of provisionality hypoparathyroidism in dissection group is much higher than those in non dissection group (P ＜ 0.05).There were no permanent hypoparathyroidism and damage of laryngeal nerve in the two groups.Postoperative outpatient follow up was 30 months,no significant differences were seen in local regional recurrence rates(6.5％ vs 10％) between the two groups (P ＞ 0.05).There were no distant metastasis occurred in the two groups.Conclusions Lymph node metastasis can be found by sentinel lymph node biopsy,it is helpful for us to decide whether dissect central lymph node or not.Carbon nanoparticles is safe,which is helpful to protect the parathyroid gland.