纳米炭在cN0分化型甲状腺癌术中的应用价值  

Application of Carbon Nanoparticles in Surgical Operation for Clinical Stage N0 Diferentiated Thyroid Carcinoma

作　　者：张惠灏[1] 朱有志[1] 吴坤琳[1] 孔令君[1] 王宗财[1] 陈玲[1] 余良飞[1] 庄和珠[1] 王燕钦[1] 陈祥锦[1] 

机构地区：[1]福建医科大学附属第一医院甲状腺乳腺外科,福建福州35000

出　　处：《武汉大学学报（医学版）》2015年第2期270-273,共4页Medical Journal of Wuhan University

基　　金：国家临床重点专科建设项目资助课题(编号:国卫办医函[2013]544号)

摘　　要：目的:研究纳米炭在临床颈淋巴结阴性(cN0)分化型甲状腺癌(DTC)手术中的应用价值。方法:选择90例cN0DTC患者,随机分为2组:使用纳米炭组和未使用组各45例,均行全甲状腺切除术加患侧中央区淋巴结清扫,统计中央区淋巴结清扫个数、微小淋巴结个数、转移淋巴结个数、转移例数、染色淋巴结个数及转移情况、甲状旁腺误切个数,监测术后24,48,72h血钙、血磷、甲状旁腺激素的水平,记录甲状旁腺功能减退及喉返神经、喉上神经的损伤情况。结果:纳米炭组中央区淋巴结清扫总数、微小淋巴结、转移淋巴结个数、淋巴结转移例数、染色淋巴结转移率均高于对照组,甲状旁腺误切情况及暂时性甲状旁腺功能减退均低于对照组,差异有统计学意义(P<0.05)。永久性甲状旁腺功能减退、喉返神经损伤、喉上神经损伤发生率差异无统计学意义(P>0.05)。术后两组患者随访12-22个月,均无复发及转移、死亡发生。结论:纳米炭可明显提高cN0DTC患者中央区淋巴结的清扫数目,尤其微小(≤2mm)淋巴结的数目。染色淋巴结转移率较高,对肿瘤的准确分期及局部控制有所帮助;同时可保护甲状旁腺,减少甲状旁腺功能减退的发生。Objective：To assess the value of carbon nanoparticles in surgical operation for clinical stage N0 diferentiated thyroid carcinoma.Methods：Ninety cases diagnosed with clinical stage N0 diferentiated thyroid carcinoma were divided into two groups randomly：the carbon nanoparticles tracer group and the control group,45 cases each.They all received total resection of thyroid plus the affected side central compartment lymph node dissection.The number of lymph node,tiny lymph node,metastasis lymph node,the metastasis cases,the number of dyed lymph node and metastasis situation,parathyroid gland for faulty excision were all collected.The calcium and phosphorus,parathyroid hormone levels in the blood were monitored in 24,48,72 hours after operarion.Hypoparathyroidism,the damage of laryngeal recurrent nerve and superior laryngeal nerve were recorded.Results：In the tracer group,the number of lymph node,tiny lymph node（≤2mm）,metastasis lymph node,metastasis cases,metastasis rate of dyed lymph node weremuch more than those of control group（P0.05）.Parathyroid gland for faulty excision and provisionality hypoparathyroidism in the tracer group were less than those of control group（P0.05）.There were no significant differences in permanent hypoparathyroidism,and the damage of laryngeal recurrent nerve or superior laryngeal nerve（P0.05）.The patients had been followed-up for 12-22 months without death,recurrence and metastasis.Conclusion：The carbon nanoparticles can obviously improve the number of lymph nodes in central compartment lymph node dissection,especially the number of tiny lymph nodes（≤2mm）,for the patient who was diagnosed with clinical stage N0 differentiation thyroid carcinoma.The metastasis rate of dyed lymph node is higher.It is helpful for accurate staging and local tumor control,protect the parathyroid gland,and decreases incidence of hypoparathyroidism.

关 键 词：纳米炭 临床颈淋巴结阴性 分化型甲状腺癌 淋巴示踪剂 甲状旁腺 

分 类 号：R653[医药卫生—外科学] R736.1[医药卫生—临床医学]