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背景与目的:甲状腺癌的发病率逐年增高,其手术并发症甲状旁腺和喉返神经损伤的发生风险高。该研究旨在探讨纳米碳负显影技术在甲状腺乳头状癌(papillary thyroid carcinoma,PTC)根治术中的操作技巧及对喉返神经与甲状旁腺的保护疗效,从而减少此类并发症的发生。方法:收集2015年4—8月收治的48例初治PTC患者的临床病理学资料并随机分为两组。A组(24例)常规采用精细被膜解剖法行单侧甲状腺腺叶切除/全甲状腺切除+单/双中央组淋巴结清扫术;B组(24例)则在稍游离甲状腺后注射纳米碳5 min后再行常规操作。比较分析两组手术时间、术中出血量、神经损伤发生率、暂时性低钙血症发生率、淋巴结清扫数及转移比率等临床资料差异。结果:对于单侧甲状腺腺叶切除+中央组淋巴结清扫术患者,B组除淋巴结清扫数较A组明显增多外(P<0.05),其他各项指标在两组间差异无统计学意义(P>0.05)。对于全甲状腺切除+双侧中央组淋巴结清扫术患者,B组手术时间、暂时性低钙血症发生率显著低于A组(P<0.05),淋巴结清扫数明显高于A组(P<0.05)。B组中单/双侧黑染淋巴结中癌转移率分别为26.7%和33.3%,非黑染淋巴结阳性转移率分别为11.8%和25.9%。结论:纳米碳负显影技术在PTC根治术中有利于甲状旁腺的保护及清扫淋巴结数目的提高,尤其是在双侧甲状腺癌根治术中的优势更为明显。
BACKGROUND & OBJECTIVE: The incidence of thyroid cancer is increasing year by year. The risk of parathyroid and recurrent laryngeal nerve injury is high. The purpose of this study was to investigate the technique of nanometer carbon negative imaging in the treatment of papillary thyroid carcinoma (PTC) and the protection of the recurrent laryngeal nerve and parathyroid gland, so as to reduce the occurrence of such complications. Methods: The clinicopathological data of 48 newly diagnosed PTC patients admitted from April to August in 2015 were collected and randomly divided into two groups. In group A (24 cases), unilateral thyroid gland lobectomy / total thyroidectomy + single / double center lymph node dissection was performed by fine dissection. In group B (24 cases), carbon nanotubes were injected slightly after leaving the thyroid for 5 min After the routine operation. The clinical data of two groups were compared, such as operation time, intraoperative blood loss, incidence of nerve injury, incidence of transient hypocalcemia, number of lymph node dissection and metastasis rate. Results: In patients with unilateral thyroidectomy and central lymph node dissection, the number of lymph node dissection in group B was significantly higher than that in group A (P <0.05), and there was no significant difference in other indexes between the two groups (P > 0.05). For total thyroidectomy + bilateral central lymph node dissection, the incidence of transient hypocalcemia in group B was significantly lower than that in group A (P <0.05), and the number of lymph node dissection was significantly higher than that in group A (P <0.05 ). In Group B, the rates of metastasis in single / bilateral black-stained lymph nodes were 26.7% and 33.3%, respectively, and those in non-black stained lymph nodes were 11.8% and 25.9%, respectively. CONCLUSION: Nano-carbon negative imaging technique is helpful for the protection of parathyroid gland and the number of lymph nodes in PTC, especially for the radical thyroidectomy.