纳米炭混悬注射液在双侧甲状腺癌切除术中对甲状旁腺的保护作用研究  

Nano Carbon Suspension for Protection of Parathyroid Gland in Bilateral Thyroid Carcinoma Resection

作　　者：孙燕翔[1] 杨乐[1] 冯煜[1] 刘兆龙[1] SUN Yanxiang;YANG Le;FENG Yu;LIU Zhaolong(Department of General Surgery,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China)

机构地区：[1]上海中医药大学附属曙光医院普外科,上海201203

出　　处：《医学综述》2020年第19期3943-3946,3952,共5页Medical Recapitulate

摘　　要：目的探讨纳米炭混悬注射液在双侧甲状腺癌切除术中对甲状旁腺的保护作用。方法选取2017年1月至2018年12月在上海中医药大学附属曙光医院治疗的80例双侧甲状腺癌患者作为研究对象,根据术中示踪剂使用不同分为纳米炭组(n=40)和亚甲蓝组(n=40)。纳米炭组患者注射纳米炭混悬注射液后行双侧甲状腺切除术+中央区淋巴结清扫治疗,亚甲蓝组使用亚甲蓝注射液后行双侧甲状腺切除术+中央区淋巴结清扫治疗。比较两组患者的手术时间、术中出血量、住院时间、起始示踪时间、Ⅵ区淋巴结清扫数、淋巴结转移数以及甲状旁腺误切率,手术前后外周血甲状旁腺激素(PTH)和血钙的水平。结果纳米炭组患者的手术时间、术中出血量及住院时间与亚甲蓝组患者比较,差异无统计学意义(P>0.05);纳米炭组Ⅵ区淋巴结清扫数、淋巴结转移数均高于亚甲蓝组[(8.6±1.6)枚比(5.3±0.5)枚、(1.8±0.4)枚比(0.9±0.3)枚](P<0.01);纳米炭组的甲状旁腺误切率显著低于亚甲蓝组[5.0%(2/40)比30.0%(12/40)](P<0.01);纳米炭组起始示踪时间显著早于亚甲蓝组[(23.4±8.2)s比(35.2±10.7)s](P<0.01);手术后两组患者的血钙和PTH水平均较术前降低,但纳米炭组患者血钙和PTH的水平均高于亚甲蓝组(P<0.05)。结论行双侧甲状腺癌手术时注射纳米炭混悬注射液可更彻底地清除Ⅵ区淋巴结,更好地保护甲状旁腺,明显降低术后低钙和低PTH的发生率,减少甲状旁腺损伤。Objective To investigate the protective effect of nano-carbon suspension on parathyroid gland in bilateral thyroidectomy.Methods Eighty patients with bilateral thyroid cancer treated in Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from Jan.2017 to Dec.2018 were included in the study,and divided into a nano-carbon group(n=40)and methylene blue group(n=40)according to the different tracers.Patients in the nano-carbon group received bilateral thyroidectomy plus central lymph node dissection after injection of carbon nanoparticles suspension injection,while those in the methylene blue group received bilateral thyroidectomy plus central lymph node dissection after injection of methylthioninium chloride injection.The operation time,intraoperative blood loss,hospital stay,initial tracer time,the number of lymph node dissection in areaⅥ,number of metastatic lymph nodes in areaⅥand the rate of misresection were compared between the two groups.The levels of parathyroid hormone(PTH)and serum calcium in peripheral blood of the two groups were compared before and after operation.Results There was no significant difference in operation time,intraoperative blood loss and hospital stay between the two groups(P>0.05).The number of dissected lymph nodes in areaⅥand metastatic lymph nodes in the nano-carbon group were higher than those in the methylene blue group[(8.6±1.6)vs(5.3±0.5),(1.8±0.4)vs(0.9±0.3)](P<0.01).The misresection rate of parathyroid gland in the nano-carbon group was significantly lower than that in the methylene blue group[5.0%(2/40)vs 30.0%(12/40)](P<0.01),and the initial tracer time of the nano-carbon group was significantly earlier than that of the methylene blue group[(23.4±8.2)s vs(35.2±10.7)s](P<0.01).After operation,the levels of plasma calcium and PTH in the two groups were lower than those before operation,but the levels of plasma calcium and PTH in the nano-carbon group were higher than those in the methylene blue group(P<0.05).Conclusion Injection of na

关 键 词：双侧甲状腺癌 双侧甲状腺切除术 Ⅵ区淋巴结清扫 纳米炭 甲状旁腺保护 

分 类 号：R736.1[医药卫生—肿瘤]