纳米碳甲状旁腺负显影技术在甲状腺癌手术中的应用
Application of Carbon Nano Negative Parathyroid Imaging in Thyroid Cancer Surgery
-
摘要: 目的 探讨在甲状腺癌根治术中应用纳米碳显影技术彻底清扫淋巴结同时保护甲状旁腺的价值.方法将130例甲状腺癌随机平均分为实验组与对照组各65例, 实验组注射纳米碳混悬液后按黑染淋巴结的范围清扫患侧VI区淋巴结, 对照组常规清扫患侧VI区淋巴结.对2组淋巴结清扫总数、淋巴结转移数、甲状旁腺误切数、发生暂时性低钙血症和永久性低钙血症例数、淋巴结转移率和甲状腺误切率进行比较分析.结果 实验组共清扫淋巴结406枚, 对照组共清扫淋巴结267枚, 实验组淋巴结转移数为106枚, 而对照组63枚, 2组间差异均有统计学意义 (P<0.01) .实验组与对照组淋巴结转移率分别为26.11%和23.61%, 2组间差异无统计学意义 (P>0.05) ;实验组术后未找到甲状旁腺, 发生短暂性低钙血症2例, 未发生永久性低钙血症, 对照组术后找到甲状旁腺组织4例, 发生短暂性低钙血症12例, 发生永久性低钙血症4例, 2组间差异具有统计学意义 (P<0.05) ;实验组和对照组甲状旁腺误切率分别为0%和1.08%, 2组间差异具有统计学意义 (P<0.05) .结论 纳米碳在甲状腺癌根治术中能够使VI区淋巴结得到很好的显影, 而甲状旁腺呈负显影, 有利于淋巴结彻底清扫, 避免甲状旁腺的误切, 提高了手术精度及安全性.Abstract: Objective To explore the application of carbon nano negative parathyroid imaging in radical operation of thyroid carcinoma.Methods 130 cases of thyroid cancer were randomly divided into experimental group and control group, each group had 65 cases, The experimental group was injected with nano carbon suspension to clean the ipsilateral VI lymph nodes according to the range of black stained lymph nodes, patients in control group were treated with VI lymph node dissection.Of the two groups of total lymph nodes, the number of lymph node metastasis, inadvertent parathyroidectomy, a transient hypocalcemia and permanent hypocalcemia cases, lymph node metastasis rate and thyroid resection rate were analyzed.Result In the experimental group, 406 lymph nodes were dissected, and the control group was given a total of 267 lymph nodes.The number of lymph node metastasis in the experimental group was 106, while the control group was 63, the difference between the two groups was statistically significant (P<0.01) .The lymph node metastasis rate of the experimental group and the control group were 26.11% and 23.61%, respectively.There was no significant difference between the two groups (P>0.05) .The experimental group did not find the parathyroid gland, transient hypocalcemia in 2 cases, no permanent hypocalcemia, find the parathyroid tissue after surgery in the control group of 4 cases, 12 cases of transient hypocalcemia, 4 cases of permanent hypocalcemia, differences between the two groups had statistical significance (P<0.05) .The experimental group and the control group were 0% and 1.08%, respectively, the difference between the two groups was statistically significant (P<0.05) .Conclusion Nano carbon in the radical operation of thyroid cancer can make the VI region lymph node is very good imaging, but the parathyroid is negative imaging, It is helpful for the dissection of lymph nodes, avoiding the wrong cutting of parathyroid gland, and improving the accuracy and safety of operation.
-
Key words:
- Nano carbon particle /
- Parathyroid /
- Thyroid carcinoma /
- Lymph node
-
[1] [1]COOPER D S, DOHERTY G M, HAUGEN B R, et al.Management guidelines for patients with thyroid nodule-s and differentiated thyroid cancer[J].Thyroid, 2006, 16 (2) :109-142. [2] [2]SEBASTIAN S O, GONZALEZ J M, PARICIO P P, et al.Papillary thyroid carcinoma:prognostic index for survival including the histological variety[J].Arch Surg, 2000, 135 (3) :272-277. [3] [3]PODUOS Y D, SMITH D, WAGMAN L D, et al.The implication of lymph node metastasis on survival in patients with well-differentiated thyroid cancer[J].Am Surg, 2005, 71 (9) :731-734. [4] [4]ZAYDFUDIM V, FEURER ID, GRIFFIN MR, et al.The impact of lymph node involvement on survival in patients with papillary and follicular thyroid carcinoma[J].Surgery, 2008, 144 (9) :1070-1077. [5]徐德全, 代文杰.分化型甲状腺癌术后促甲状腺激素抑制性治疗进展[J].S中国实用外科杂志, 2013, 33 (12) :1071-1074. [6]徐少明.我国目前应慎行甲状腺全切除术[J].中华外科杂志, 2008, 46 (5) :387-389. [7] [7]LO CY, LAM KY.Routine parathyroid autoransplantation during thyroidectomy[J].Surgery, 2001, 129 (3) :318-323. [8] [8]KHAIRY G A, AL-SAIF A.Incidental parathyroidectomy during thyroid resection:incidence, risk factors, and outcome[J].Ann Saudi Med, 2011, 31 (3) :274-278. [9]陈万志, 吕云霞, 谢嵘, 等.纳米碳在甲状腺癌手术中甲状旁腺保护的应用[J].临床耳鼻咽喉头颈外科杂志, 2014, 28 (24) :1918-1920. [10] [10]YOKOTA T, SAITO T, NARUSHIMA Y, et al.Lymphnode staining with activated carbon CH40:a newmethod for axillary lymph-node dissection in breast cancer[J].Can J Surg, 2000, 43 (3) :191-196. [11] [11]YAN J, ZHENG X, LIU Z, et al.A multicenter study of using carbon nanoparticles to show sentinel lymph nodes in early gastric cancer[J].Surg Endosc, 2016, 30 (4) :1294-1300. [12]曹永宽, 王永华, 刘立业, 等.手助腹腔镜胃癌淋巴结清扫规范性的临床研究[J].中国普通外科杂志, 2012, 21 (10) :1187-1190. [13]江国斌, 方红燕, 蔡建明.纳米碳混悬液示踪前哨淋巴结在甲状腺乳头状癌中的应用[J].中国癌症杂志, 2010, 20 (12) :938-940. [14]贾中明, 刘艳, 黄秋林.纳米碳定位前哨淋巴结在c N0甲状腺乳头状癌中的临床研究[J].临床合理用药杂志, 2011, 9 (4) :9-12. [15]吴干勋, 蔡丽, 胡俊兰, 等.纳米碳在甲状腺癌行甲状腺全切加双侧中央区清扫中的作用[J].中华医学杂志, 2015, 95 (12) :912-916.
点击查看大图
计量
- 文章访问数: 2051
- HTML全文浏览量: 592
- PDF下载量: 70
- 被引次数: 0