纳米炭结合精细被膜解剖法对甲状腺癌术中喉返神经及甲状旁腺保护作用观察  

Protective effect of nanocarbon combined with fine capsule anatomy on recurrent laryngeal nerve and parathyroid gland during thyroid cancer surgery

作　　者：孙志强[1] 宋智明[1] 孙福良 杨莉萍[1] SUN Zhi-qianp;SONG Zhi-ming;SUN Fu-liang;YANG Li-ping(Department of Thyroid.Surgery,Jiangsu Institute of Atomic Medicine Affiliated Jiangyuan Hospital,Wuxi 214063,China)

机构地区：[1]江苏省原子医学研究所附属江原医院甲状腺外科,江苏无锡214063

出　　处：《哈尔滨医科大学学报》2021年第1期55-58,共4页Journal of Harbin Medical University

基　　金：江苏省社会科学基金项目(13SHD016)。

摘　　要：目的探讨纳米炭结合精细被膜解剖法对甲状腺癌术中喉返神经及甲状旁腺的保护作用。方法选取50例行全甲状腺切除术的甲状腺乳头状癌患者,根据摸球法将患者分为联合组及精细被膜解剖组,各25例。精细被膜解剖组采用精细被膜解剖法进行全甲状腺切除术,联合组在精细被膜解剖组基础上注射纳米炭后进行手术。观察两组患者治疗前后外周血钙、甲状旁腺激素(PTH)水平,淋巴结清扫总数、淋巴结直径、转移淋巴结数目,甲状旁腺组织检出情况,甲状旁腺误切、低钙血症、喉返神经损伤发生情况。结果术前两组外周血钙和PTH差异无统计学意义(P>0.05),术后第3天及术后1个月,两组血钙和PTH均较术前降低(均P<0.05)。术后第3天及术后1个月联合组血钙和PTH均较精细被膜解剖组增高(均P<0.05)。联合组清扫淋巴结总数为235枚,精细被膜解剖组清扫160枚淋巴结,联合组平均淋巴结清扫数目、淋巴结直径<5 mm比例高于精细被膜解剖组(均P<0.05)。联合组甲状旁腺误切率(0.00%)低于精细被膜解剖组(20.0%)(χ^(2)=5.556,P=0.018)。联合组病理甲状旁腺组织检出率(4.00%)低于精细被膜解剖组(32.00%)(χ^(2)=6.640,P=0.010)。联合组并发症发生率(4.00%)低于精细被膜解剖组(28.00%),差异具有统计学意义(χ^(2)=5.357,P=0.021)。结论纳米炭结合精细被膜解剖法可提高甲状腺癌术中喉返神经及甲状旁腺保护作用,并提高微小淋巴结清扫率,临床应用价值较高。Objective To explore the protective effect of nanocarbon combined with fine capsule anatomy on the recurrent laryngeal nerve and parathyroid glands during thyroid cancer surgery.Methods Fifty patients with papillary thyroid carcinoma who underwent total thyroidectomy were selected,and the patients were divided into a combined group and a fine capsule anatomy group,with 25 cases in each group.In the fine capsule anatomy group,a fine capsule dissection method was used for total thyroidectomy.The combined group was injected with nano-carbon for surgery on the basis of the fine capsule anatomy group,the combined group was injected with nano-carbon for surgery.The peripheral blood calcium,parathyroid hormone levels,total lymph node dissection,lymph node diameter,number of metastatic lymph nodes,the detection of parathyroid tissue,hypoparathyroidism,hypocalcemia,and recurrent laryngeal nerve injury in the two groups of patients were observed.Results There was no significant difference in peripheral blood calcium and PTH between the two groups before surgery(P>0.05).On the 3 rd day and 1 month after operation,the blood calcium and PTH of the two groups were lower than before surgery(both P<0.05).On the 3 rd day and 1 month after operation,the blood calcium and PTH in the combination group were higher than those in the fine capsule anatomy group(both P<0.05).The total number of lymph nodes dissected in the combined group was 235,and 160 lymph nodes were dissected in the fine capsule dissection group.The average number of lymph node dissections and the diameter of the lymph nodes<5 mm in the combined group were higher than those in the fine capsule dissection group(all P<0.05).The paraparathyroidectomy rate(0.00%)in the combined group was lower than that in the fine capsule anatomy group(20.0%)(χ^(2)=5.556,P=0.018).The detection rate of pathological parathyroid tissue in the combined group(4.00%)was lower than that in the fine capsule anatomy group(32.00%)(χ^(2)=6.640,P=0.010).The incidence of complications in the combi

关 键 词：纳米炭 精细被膜解剖法 甲状腺癌 喉返神经 甲状旁腺 

分 类 号：R736.1[医药卫生—肿瘤]