应用纳米碳对甲状腺癌颈淋巴结清扫及甲状旁腺保护的作用

目的 分析甲状腺癌患者行甲状腺全切术联合双侧中央区淋巴结清扫术中应用纳米碳对淋巴结处理及甲状旁腺保护的作用。方法 采用随机对照研究，分析本院70例甲状腺癌患者的临床资料，均行甲状腺全切术联合双侧中央区淋巴结清扫术，根据术中是否应用纳米碳，分为干预组术中应用纳米碳，对照组术中未应用纳米碳，两组各35例。比较两组淋巴结清扫数、转移数及手术前后甲状旁腺素（PTH）水平等差异。结果 干预组平均每例患者淋巴结清扫数为（10.07±3.15）枚，较对照组的（6.13±1.96）枚明显增多（P<0.05）；干预组平均每例患者检出淋巴结转移数[(3.85±1.03)枚]与对照组的转移数[(3.57±1.14)枚]比较，并无明显差异（P>0.05）。干预组应用纳米碳，甲状腺均出现黑染，其平均每例患者中央区清扫标本淋巴结黑染数为1~12枚，共322枚，占检出淋巴结总数的91.48%（322/352），平均每例黑染的淋巴结数为（9.20±2.24）枚，较对照组检出的淋巴结数明显增多（P<0.01）。干预组患者中央区清扫组织甲状旁腺检出率（2.86%）与对照组的检出率（14.29%）比较，并无明显差异（P>0.05）。相比术前水平，对照组患者术后PTH水平明显下降（P<0.05）；干预组术后PTH水平与术前水平相比，并无明显差异（P>0.05）；相比对照组，干预组术后PTH水平显著升高（P<0.05）。相比术前水平，对照组患者术后血钙水平明显下降（P<0.05）；干预组术后血钙水平与术前水平相比，并无明显差异（P>0.05）；相比对照组，干预组术后血钙水平显著升高（P<0.05）。两组患者均未出现高钙血症，其中对照组出现低钙症状6例，干预组3例；两组低钙症状发生率的比较，并无明显差异（P>0.05）。术后7 d内血钙< 2.2 mmol/L无症状患者共32例，其中对照组19例，干预组13例。结论 甲状腺癌患者行甲状腺全切术联合双侧中央区淋巴结清扫术中应用纳米碳可有效清扫淋巴结，对淋巴结处理及甲状旁腺保护均具有重要作用。

Effects of carbon nanoparticles on neck lymph node dissection and parathyroid gland protection in thyroid cancer

Objective To analyze the effect of carbon nanoparticles on lymph node management and parathyroid protection in patients with thyroid cancer undergoing total thyroidectomy combined with bilateral central lymphadenectomy. Methods A randomized controlled study was conducted to analyze the clinical data of 70 patients with thyroid cancer in our hospital. All patients underwent total thyroidectomy combined with bilateral central lymphadenectomy. According to whether carbon nanoparticles was used during operation, they were divided into intervention group and control group. The number of lymph node clearance, the number of metastases, and the level of parathyroid hormone (PTH) before and after operation were compared between the two groups. Results The average number of lymph node dissection in the intervention group was (10.07±3.15), which was significantly higher than that in the control group (6.13±1.96) (P < 0.05), and the average number of lymph node metastasis in the intervention group [(3.85±1.03)] was not significantly different from that in the control group [(3.57±1.14)] (P > 0.05). The average number of black stained lymph nodes in the central area of each patient was 1-12, accounting for 91.48% (322/352) of the total number of detected lymph nodes. The average number of black stained lymph nodes in each case was (9.20±2.24), which was significantly higher than that in the control group (P < 0.01). There was no significant difference in the detection rate of parathyroid glands between the intervention group and the control group (2.86%) in the central area (14.29%) (P > 0.05). Compared with the preoperative level, the PTH level in the control group decreased significantly (P < 0.05); there was no significant difference between the preoperative level and the post-operative PTH level in the intervention group (P > 0.05); compared with the control group, the post-operative PTH level in the intervention group increased significantly (P < 0.05). Compared with the preoperative level, the level of serum calcium in the control group decreased significantly (P < 0.05); there was no significant difference in the level of serum calcium between the intervention group and the preoperative level (P > 0.05); compared with the control group, the level of serum calcium in the intervention group increased significantly (P < 0.05). There was no hypercalcemia in the two groups, including 6 cases in the control group and 3 cases in the intervention group. There was no significant difference in the incidence of hypocalcemia between the two groups (P > 0.05). In 7 days after operation, there were 32 cases of serum calcium < 2.2 mmol/L asymptomatic patients, including 19 cases in the control group and 13 cases in the intervention group. Conclusion Lymph nodes can be effectively removed by using carbon nanoparticles in total thyroidectomy combined with bilateral central lymph node dissection. increase the number of lymph node dissection in patients with thyroid cancer, which plays an important role in lymph node management and parathyroid protection.