纳米碳在cN0期甲状腺乳头状癌中央区淋巴结清扫手术中的应用  

The Applied Significance of Carbon Nanoparticles in Central Compartment Lymph Node Dissection in Treatment of cN0 Papillary Thyroid Carcinoma

作　　者：杨志芳[1] 岳瑞雪[1] 朱智[1] 逯超[1] 夏文飞[1] 易继林[1] 李兴睿[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院甲乳外科,湖北武汉430030

出　　处：《中国普外基础与临床杂志》2013年第9期976-980,共5页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的研究纳米碳混悬液示踪技术在cN0期甲状腺乳头状癌中央区淋巴结清扫手术中的应用价值。方法将2012年5～10月期间在笔者所在医院科室治疗的68例cN0期甲状腺乳头状癌患者随机分为2组：未使用纳米碳淋巴示踪剂（对照组）32例，使用纳米碳淋巴示踪剂（示踪组）36例，均行甲状腺全切除术、患侧和（或）对侧中央区（Ⅵ区）淋巴结清扫术。比较2组患者的淋巴结清扫数、淋巴结转移情况以及手术相关指标（手术时间、术中出血量、术后引流时间和住院时间）。结果对照组和示踪组分别清扫中央区淋巴结205枚和324枚。其中，对照组手术清扫中央区淋巴结（6．41±1．56）枚／例，示踪组为（8．99±2．24）枚／例，多于对照组（P〈0．001）。对照组的中央区淋巴结转移率为40．6％（13／32），与示踪组（47．2％，17／36）相比差异无统计学意义（P=0．762），但示踪组喉返神经内侧区的淋巴结转移率（38．9％，14／36）高于对照组（12．5％，4／32），P=0．029。2组患者的手术时间、术中出血量、术后引流时间、住院时间、术后切口出血发生率、一过性低血钙发生率及喉上神经损伤发生率比较差异均无统计学意义（P〉0．05）。2组患者术后均随访6个月，均无术后肿瘤复发、转移及死亡发生。结论纳米碳淋巴示踪技术可明显提高cN0期甲状腺乳头状癌患者中央区淋巴结的清扫数目，能比较准确地反映淋巴结的转移情况，从而对肿瘤进行准确的分期，以指导术后治疗，同时不增加（或延长）术中出血量、手术时间、术后住院时间及手术并发症发生率。Objective To assess the applied significance of carbon nanoparticles in central compartment lymph node dissection in treatment of cN0 papillary thyroid carcinoma. Methods Sixty-eight patients with cN0 papillary thyroid carcinoma who were treated in Tongji Hospital of Tongji Medical College from May. to Oct. in 2012 were randomly allocated to the control group （n：32） and the carbon nanoparticles trace group （tracer group, n-36）, receiving non-carbon nanoparticles trace and carbon nanoparticles trace respectively. All patients were received total resection of thyroid plus the affected side and （or） contralateral side central compartment lymph node dissection. The lymph node-related indexes （including number of dissected lymph node at Ⅵ area and lymph node metastasis rate at VI area） and operative indexs （including operation time, blood loss, drainage time, complication, and hospital stay） were collected and compared between the 2 groups. Results There were 205 and 324 dissected lymph node at central compartment in control group and tracer group respectively. The results of postoperative pathology showed that the number of lymph node in central compartment of the tracer group was much more than those of control group （8.99±2.24 vs. 6. 41 ± 1.56, P〈0. 001）. The metastasis rate of central compartment lymph node were 40. 6% （13/32） in control group and 47.2% （17/36） intracer group, but there was no significant difference between the 2 groups （P=0. 762）. But in medial area of laryngeal recurrent nerve, the metastasis rate in the tracer group （38.9%, 14/36） was much higher than those of control group （12.5%, 4/32）, P=0. 029. There were no significant differences in the operation time, blood loss, drainage time, hospital stay, and complication incidence such as bleeding, temporary hypocalcemia, and injury of superior laryngeal nerve between 2 groups （P〉0. 05）. All the patients in 2 groups had followed-up for 6 months without death, recurrence, and metastasis. Concl

关 键 词：纳米碳 甲状腺乳头状癌 淋巴示踪剂 淋巴结转移 

分 类 号：R736.1[医药卫生—肿瘤]