纳米碳混悬液在甲状腺癌颈部淋巴结清扫和甲状旁腺保护中的临床应用

目的:探讨纳米碳混悬液在甲状腺癌手术中对颈部淋巴清扫的引导作用和甲状旁腺功能的保护价值?方法:对同时实施甲状腺全切除及患侧颈部淋巴清扫的120例分化型甲状腺癌病例随机分为2组进行前瞻性研究,其中60例在术中甲状腺注射纳米碳混悬液(纳米碳组),60例行常规手术(对照组)?分别统计两组手术时间?术中出血量?术后引流量?术中甲状旁腺移植病例数?cN0和cN1的清扫淋巴结总数和直径<5 mm淋巴结数量及转移率?术后甲状旁腺激素水平?血清钙浓度及术后出现低钙血症病例数?结果:纳米碳混悬液组手术时间长(P=0.002),术中出血?术后引流量无明显差异(P > 0.05);纳米碳混悬液组清扫淋巴结较对照组多(P=0.000 1)?在cN0病例中纳米碳混悬液使得淋巴结清扫总数和直径<5 mm的淋巴结清扫数目明显多于对照组(P=0.000 1),但在cN1病例中两组淋巴结总数无明显差异(P=0.086),但有助提高直径<5 mm淋巴结的检出数(P=0.000 1)?对照组术后低钙血症多于纳米碳组(P=0.001)?结论:纳米碳混悬液有助于提高甲状腺癌cN0病例转移性淋巴结的检出数,尤其是直径<5 mm淋巴结的检出数,同时对甲状旁腺功能具有保护作用?

The role of carbon nanoparticles suspension for cervical lymphadenectomy and protection of parathyroid functionin patients with papillary thyroid cancer

Objective:To investigate the clinical utility of carbon nanoparticles suspension as lymph node tracer in the cervical lymphadenectomy and protection function of parathyroid in patients with papillary thyroid cancer. Methods:One hundred twenty consecutive patients were divided into carbon nanoparticles suspension group(n=60) and control group(n=60) for prospective studies. All patients underwent total thyroidectomy with unilateral cervical lymphadenectomy. The operating time,operative blood loss,postoperative drainage volume,the numbers of parathyroid autotransplantation,the total number of cleaning lymph nodes(cN0 and cN1) and the diameter < 5 mm lymph node,and metastasis lymph nodes,the parathyroid hormone(PTH),the serum calcium level,and the cases of hypocalcemia after surgery were compared between the two groups. Results:The operating time was longer than that of the control group(P=0.002),operative blood loss and postoperative drainage volume had no statistically significant difference between the two groups(P > 0.05). Carbon nanoparticles suspension group cleaned out 519 pieces of lymph nodes(average 10.6),was compared with the control 293 pieces of lymph nodes(average 6.9)(P=0.000 1). In cN0 cases,the total numbers of lymph node cleaning and diameter < 5 mm lymph node with carbon nanoparticles suspension were obviously more than the control group(P=0.000 1),but in the cN1 cases,there was no difference on the total number of lymph nodes(P=0.086) between the two groups,yet it was helpful for the diameter < 5 mm lymph node inspection(P=0.000 1). Postoperative hypocalcemia of the controls was more than the carbon nanoparticles suspension group(P=0.001). Conclusion:Carbon nanoparticles suspension might help to detect metastatic lymph nodes with thyroid cancer cN0,especially diameter < 5 mm lymph node inspection,and protect the function of the parathyroid gland.