纳米碳注射在3D 腔镜甲状腺癌手术中的应用

Application of Nano-Carbon in lymph node dissection and protection of parathyroid glands in 3D laparoscopic thyroidectomy

摘要:

目的 探索纳米碳在3D 腔镜cN0 期甲状腺癌中央区清扫和甲状旁腺保护的应用价值。方法 回 顾性分析近3 年在笔者单位行3D 腔镜甲状腺癌根治术患者65 例，均行患侧腺叶全切+ 中央区Ⅵ淋巴清扫术， 比较实验组33 例（使用纳米碳混悬液）和对照组32 例清扫中央区淋巴结数目、转移率、冰冻病理甲状旁 腺阳性率、术后24 h 低血钙发生率和术后48 h 甲状旁腺激素（PTH）水平。结果 两组在清扫淋巴结数量 和术中冰冻甲状旁腺阳性率的比较差异具有统计学意义（t =2.68，P =0.008 ；χ2=8.97，P =0.003）；术后48 h PTH 水平差异具有统计学意义（t =3.21，P =0.003）；转移淋巴结数目差异（χ2=2.76）、术后24 h 低钙血症 发生率（χ2=1.17）比较差异无统计学意义（P >0.05）。结论 3D 腔镜联合术中纳米碳注射的合理运用，有 效地保护甲状旁腺避免术中副损伤，提高了中央区淋巴清扫的彻底性，具有临床推广价值。

Abstract:

Objective To explore the clinical significance of Nano-Carbon particles and 3D laparoscopy in central compartment lymph node dissection and parathyroid glands protection in treatment of cN0 thyroid cancer. Methods We conduct a retrospective analysis of sixty-five patients with cN0 thyroid cancer who were received 3D laparoscopic thyroidectomy in the last 3 years. All patients were received total resection of thyroid plus the affected side and (or) contralateral side central compartment lymph node dissection. All patients were allocated to control group (n = 32) and carbon nano-particles trace group (tracer group, n = 33). The lymph node-related indexes (including number of dissected lymph node at Ⅵ area, number of Metastatic lymph node and Frozen lymph node-positive rate at Ⅵ area), serum calcium (24 h after surgery) and PTH (48 h after surgery) were collected and compared between the 2 groups. Results Number of dissected lymph node at Ⅵ area, positive rates of intraoperative frozen-section examination of parathyroid glands and PTH (48 h after surgery) were found statistical higher in nanoparticles group than control (P < 0.05). No statistical difference were found in Number of Metastatic lymph node and serum calcium (24 h after surgery) (P < 0.05). Conclusion The clinical significance of carbon nanoparticles and 3D laparoscopy is effective and feasible for central compartment lymph node dissection and parathyroid glands protection in treatment of cN0 thyroid cancer.