中国癌症杂志 ›› 2016, Vol. 26 ›› Issue (7): 635-640.doi: 10.19401/j.cnki.1007-3639.2016.07.012

• 论著 • 上一篇    

纳米碳负显影在甲状腺乳头状癌根治性手术应用中的疗效分析

蔡辉华,安 勇,薛 卫,孙冬林,陈学敏,张 悦,刘胜勇,段云飞,吴新权,陈 晶   

  1. 常州市第一人民医院普通外科,苏州大学附属第三医院,江苏 常州 213003
  • 出版日期:2016-07-30 发布日期:2016-08-22
  • 通信作者: 薛 卫 E-mail:xueweichangzhou@163.com

The value of carbon nano-particles-labeled lymph nodes in neck dissection for papillary thyroid cancer

CAI Huihua, AN Yong, XUE Wei, SUN Donglin, CHEN Xuemin, ZHANG Yue, LIU Shengyong, DUAN Yunfei, WU Xinquan, CHEN Jing   

  1. Department of General Surgery, the First People’s Hospital of Changzhou, the 3th Hospital Affiliated to Soochow University, Changzhou 213003, Jiangsu Province, China
  • Published:2016-07-30 Online:2016-08-22
  • Contact: XUE Wei E-mail: xueweichangzhou@163.com

摘要: 背景与目的:甲状腺癌的发病率逐年增高,其手术并发症甲状旁腺和喉返神经损伤的发生风险高。该研究旨在探讨纳米碳负显影技术在甲状腺乳头状癌(papillary thyroid carcinoma,PTC)根治术中的操作技巧及对喉返神经与甲状旁腺的保护疗效,从而减少此类并发症的发生。方法:收集2015年4—8月收治的48例初治PTC患者的临床病理学资料并随机分为两组。A组(24例)常规采用精细被膜解剖法行单侧甲状腺腺叶切除/全甲状腺切除+单/双中央组淋巴结清扫术;B组(24例)则在稍游离甲状腺后注射纳米碳5 min后再行常规操作。比较分析两组手术时间、术中出血量、神经损伤发生率、暂时性低钙血症发生率、淋巴结清扫数及转移比率等临床资料差异。结果:对于单侧甲状腺腺叶切除+中央组淋巴结清扫术患者,B组除淋巴结清扫数较A组明显增多外(P<0.05),其他各项指标在两组间差异无统计学意义(P>0.05)。对于全甲状腺切除+双侧中央组淋巴结清扫术患者,B组手术时间、暂时性低钙血症发生率显著低于A组(P<0.05),淋巴结清扫数明显高于A组(P<0.05)。B组中单/双侧黑染淋巴结中癌转移率分别为26.7%和33.3%,非黑染淋巴结阳性转移率分别为11.8%和25.9%。结论:纳米碳负显影技术在PTC根治术中有利于甲状旁腺的保护及清扫淋巴结数目的提高,尤其是在双侧甲状腺癌根治术中的优势更为明显。

关键词: 纳米碳负显影, 甲状腺乳头状癌, 手术, 疗效

Abstract: Background and purpose: Thyroid carcinoma is a common endocrine tumor with an incidence that has increased over recent decades. The aim of the present study was to investigate the effectiveness of carbon nano-particles-labeled lymph nodes in neck dissection for papillary thyroid cancer (PTC), focusing on the protectiveness for the recurrent laryngeal nerve (RLN) and parathyroid glands. Methods: Forty-eight patients with PTC treated from Apr. to Aug. 2015 were randomly divided into two groups. Group A patients (24 patients) were treated with lobectomy/total thyroidectomy plus unilateral/bilateral central lymph node dissection by conventional meticulous capsular dissection technique; Group B patients (24 patients) were treated with the same surgical procedures as group A, 5 min after the injection of carbon nano-particles. The operative time, intra-operative blood loss, incidence of RLN injury, incidence of transient hypocalcemia, the number of total lymph nodes and the ratio of metastatic nodes were collected and analyzed. Results: For unilateral lobectomy, the number of lymph nodes in group B was significantly greater than that in group A (P<0.05). For total thyroidectomy, the operative time, and the incidence of transient hypocalcemia in group B were both lower than those in group A (P<0.05), and the number of total lymph nodes was significantly higher than that in group A (P<0.05). In group B, the ratio of metastatic nodes were 26.7% (unilateral) and 33.3% (bilateral) in stained lymph nodes, and 11.8% and 25.9% in non-stained lymph nodes. Conclusion: The carbon nano-particles-labeled lymph nodes in neck dissection could facilitate to protect parathyroids and increase the number of lymph nodes, especially in total thyroidectomy plus bilateral central lymph node dissection.

Key words: Carbon nano-particles, Papillary thyroid cancer, Surgery, Effectiveness