新型示踪剂盐酸米托蒽醌在甲状腺癌根治术中淋巴结显影的应用探究  

Application of mitoxantrone hydrochloride in lymph node imaging during radical thyroidectomy

作　　者：程宇 张爽 刘智伟 刘莉莉 王毅[1] 顾建华[1] Cheng Yu;Zhang Shuang;Liu Zhiwei;Liu Lili;Wang Yi;Gu Jianhua(Department of Thyroid,Breast and Hernia Surgery,Tianjin First Central Hospital,Tianjin 300192,China;Department of Pediatrics,Tianjin Dongli Hospital,Tianjin 300399,China;Department of Plastic and Burn Surgery,Tianjin First Central Hospital,Tianjin 300192,China)

机构地区：[1]天津市第一中心医院甲乳疝外科,天津300192 [2]天津市东丽医院儿科,天津300399 [3]天津市第一中心医院整形与烧伤外科,天津300192

出　　处：《中华耳鼻咽喉头颈外科杂志》2024年第10期1064-1071,共8页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：北京健康促进会甲状腺中青年医生研究项目(BJHPA-2022-JZHXZHQNYJ-LCH-12);天津市科技计划项目(23JCYBJC01730)。

摘　　要：目的探讨新型示踪剂盐酸米托蒽醌(mitoxantrone hydrochloride injection for tracing,MHI)在甲状腺癌根治术中颈部淋巴结的显影效果以及辅助甲状旁腺、喉返神经识别中的临床价值。方法采用前瞻性对照研究的方法于2022年1月至2024年4月间在天津市第一中心医院招募甲状腺癌病例180例,男性54例,女性126例,年龄26~69岁。随机分为盐酸米托蒽醌淋巴结示踪组(MHI组)、纳米炭淋巴结示踪组(纳米炭组)、无淋巴结示踪剂组(空白组),每组60例。3组患者均行全甲状腺切除及区域淋巴清扫,记录一般临床指标,对比淋巴结的检出数目、阳性转移情况、术野清晰度、甲状旁腺识别率及误切情况,分析不同时间点血清钙、甲状旁腺素(PTH)以及并发症情况。采用单因素方差分析、卡方检验和两独立样本非参数检验等统计学方法,分析3组病例的评估指标。结果MHI组和纳米炭组手术时间、颈部引流量、住院时间显著低于空白组(P值均˂0.05)。MHI组染色程度评分、示踪成功率、术野清晰度评分均显著高于纳米炭组(P值均˂0.05)。MHI组淋巴结清扫数目、阳性转移数目、甲状旁腺识别率均显著高于纳米炭组和空白组;MHI组和纳米炭组甲状旁腺误切率均显著低于空白组(P值均˂0.05)。术后1 d、5 d,MHI组血钙、PTH水平均显著高于纳米炭组和空白组;但术后1 d纳米炭组与空白组血钙水平无差异(P>0.05),纳米炭组PTH水平高于空白组,术后5 d纳米炭组上述两指标水平均高于空白组(P值均˂0.05);术后30 d,MHI组血钙、PTH水平与纳米炭组比较无差异(P值均>0.05)。MHI组和纳米炭组颜面部麻木、手足搐搦、饮水呛咳风险均低于空白组(P值均˂0.05)。结论MHI在甲状腺癌根治术区域淋巴清扫中可发挥快速靶向递送、染色术野清晰的优势,可有效降低喉返神经及甲状旁腺副损伤风险。ObjectiveTo investigate the clinical application value of the new tracer mitoxantrone hydrochloride in imaging of cervical lymph nodes and identifying of parathyroid,recurrent laryngeal nerve during thyroid cancer radical surgery.MethodsA prospective controlled study was conducted between January 2022 and April 2024 at Tianjin First Central Hospital,recruiting 180 patients with thyroid cancer,including 54 males and 126 females,aged from 26 to 69 years.The patients were randomly divided into three groups:the mitoxantrone hydrochloride lymph node tracing group(MHI group),the nanocarbon lymph node tracing group(nanocarbon group),and the control group without lymph node tracers,with 60 cases in each group.All patients underwent total thyroid resection and regional lymph node dissection.The number of detected lymph nodes and positive metastatic lymph nodes and surgical field clarity scores and the identification rate of parathyroid glands and the instances of inadvertent excision were compared between the groups.Serum calcium and parathyroid hormone(PTH)levels at different perioperative time points and treatment-related complications were analyzed.One-way ANOVA,chi-square test and two independent sample non-parametric tests,were employed for statistical analyses.ResultsThe mean operation time,neck drainage volume and hospital stay in the MHI group and the nanocarbon group were respectively significantly lower than those in the control group(P<0.05).The mean staining intensity score,tracer success rate and surgical field clarity score in MHI group were respectively significantly higher than those in nanocarbon group(P<0.05).The mean numbers of dissected lymph nodes positive metastatic nodes and identification rates of parathyroid glands in MHI group were respectively significantly higher than those in both the nanocarbon and control groups(P<0.05).The rates of inadvertent parathyroid excision in both MHI group and nanocarbon group were significantly lower than those in control group(P<0.05).On postoperative day 1 and d

关 键 词：甲状腺肿瘤 颈淋巴结清扫术 盐酸米托蒽醌 淋巴结示踪剂 甲状旁腺损伤 

分 类 号：R736.1[医药卫生—肿瘤]