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。

关键词:纳米碳;3D 腹腔镜;甲状旁腺;甲状腺癌

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.

Key words:nano-carbon; 3D laparoscopy thyroidectomy; parathyroid glands; thyroid cancer