纳米碳技术在清扫cN0期PTMC喉返神经区域淋巴结中的应用价值研究  

Study on application value of nano carbon technology in cleaning lymph nodes in the recurrent laryngeal nerve region of cN0 stage PTMC

作　　者：李文[1] 徐经薇[1] 王梅 刘文娟[1] 刘仕杰[1] LI Wen;XU Jing-wei;WANG Mei(Laiyang Central Hospital,Yantai 265200,China)

机构地区：[1]烟台市莱阳中心医院,265200

出　　处：《中国实用医药》2024年第13期71-74,共4页China Practical Medicine

摘　　要：目的 研究使用纳米碳技术清扫cN0期甲状腺微小乳头状癌(PTMC)喉返神经(RLN)区域淋巴结的临床价值。方法 108例cN0期PTMC患者,按照随机数字表法分为对照组和观察组,每组54例。观察组在清扫RLN后方淋巴结术前于甲状腺内注射0.2~0.3 ml纳米碳混悬液,对照组不注射纳米碳悬浮液。手术采用患侧甲状腺腺叶、峡部切除+患侧中央区淋巴结清扫方法;双侧PTMC患者,则采用甲状腺全切除+双颈中央区淋巴结清扫方法 ,部分侧颈淋巴结出现转移者加行侧颈淋巴结清扫术。比较两组手术时间和术中出血量,手术前后血钙(Ca)、血清甲状旁腺激素(PTH)水平,术后声音嘶哑、暂时性甲状旁腺功能低下、低血钙等并发症发生情况,平均淋巴结检出数、阳性淋巴结检出数及甲状旁腺误切、RLN损伤情况。结果 两组手术时间和术中出血量比较无显著差异(P>0.05)。术前,两组血Ca、血清PTH水平比较无显著差异(P>0.05);术后1 d,观察组血Ca、血清PTH水平分别为(2.28±0.09)mmol/L、(31.02±10.97)ng/L,高于对照组的(2.21±0.10)mmol/L、(26.59±11.48)ng/L,有显著差异(P<0.05);术后1个月,两组血Ca、血清PTH水平比较无显著差异(P>0.05)。观察组术后声音嘶哑、低血钙发生率分别为3.7%、16.7%,显著低于对照组的14.8%、33.3%,有显著差异(P<0.05);两组暂时性甲状腺功能低下发生率比较无显著差异(P>0.05)。观察组平均淋巴结检出数(7.37±1.82)枚、阳性淋巴结检出数(2.41±0.86)枚多于对照组的(6.57±1.92)、(1.98±0.88)枚,甲状旁腺误切率9.3%、RLN损伤率3.7%低于对照组的24.1%、14.8%,有显著差异(P<0.05)。结论 采用纳米碳技术清扫cN0期PTMC患者RLN区域淋巴结,提高了淋巴结检出率,降低了甲状旁腺误切率,保护了RLN,值得推广应用。Objective To study the clinical value of nano carbon technology in cleaning lymph nodes in the recurrent laryngeal nerve(RLN)region of cN0 stage papillary thyroid microcarcinoma(PTMC).Methods 108 patients with cN0 stage PTMC were selected and divided into a control group and an observation group according to random numerical table,with 54 cases in each group.The observation group injected 0.2-0.3 ml of nano carbon suspension into the thyroid gland during lymph node dissection after RLN in PTMC patients,while the control group did not inject nano carbon suspenssion.All patients should undergo at least thyroidectomy and isthmus resection on the affected side,as well as lymph node dissection in the central region of the affected side;for bilateral PTMC patients,total thyroidectomy and double neck central lymph node dissection were performed,with some cases of lateral neck lymph node metastasis also undergoing lateral neck lymph node dissection.Both groups were compared in terms of surgical time,intraoperative bleeding volume,blood calcium(Ca)and serum parathyroid hormone(PTH)levels before and after operation,postoperative complications such as hoarseness,transient hypoparathyroidism and hypocalcemia,average number of lymph nodes detected,number of positive lymph nodes detected,parathyroid misresection and RLN injury.Results There were no significant differences in surgical time and intraoperative bleeding volume between the two groups(P>0.05).Before operation,there were no significant differences in blood Ca and serum PTH levels between the two groups(P>0.05).1 d after operation,the levels of blood Ca and serum PTH in the observation group were(2.28±0.09)mmol/L and(31.02±10.97)ng/L,which were significantly higher than(2.21±0.10)mmol/L and(26.59±11.48)ng/L in the control group(P<0.05).1 month after operation,there were no significant differences in the levels of blood Ca and serum PTH between the two groups(P>0.05).The incidence of hoarseness and hypocalcemia in the observation group were 3.7%and 16.7%,which were

关 键 词：纳米碳 甲状腺微小乳头状癌 甲状旁腺 喉返神经 

分 类 号：R736.1[医药卫生—肿瘤]