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目的:探讨纳米炭混悬液示踪技术在颈淋巴结阴性(cN_0)甲状腺乳头癌中央区淋巴结清扫中的临床应用价值。方法:选取2015年9月至2016年6月期间在上海黄浦区东南医院治疗的cN_0期甲状腺乳头癌病人85例,随机挑选45例病人使用纳米炭淋巴示踪剂(示踪组),另40例病人未使用纳米炭淋巴示踪剂(对照组)。所有病人均行甲状腺全切除术以及患侧或双侧中央区淋巴结清扫术,比较两组病人的淋巴结清扫数以及淋巴结转移情况。结果:示踪组和对照组清扫淋巴结总数分别为294枚和116枚。示踪组清扫中央区淋巴结(6.5±5.3)枚,显著高于对照组清扫淋巴结(2.9±2.2)(P<0.001)。示踪组淋巴结转移率37.8%(17/45)与对照组45.0%(18/40)无统计学差异(P=0.499)。示踪组和对照组阳性淋巴结分别为(1.2±2.2)和(0.7±0.8),无统计学差异(P=0.119)。淋巴结转移病人中,示踪组清扫淋巴结数多于对照组(P=0.007)。两组病人术后均随访6个月,未发现肿瘤复发、转移及死亡。结论:纳米炭淋巴示踪技术可显著提高cN_0期甲状腺乳头癌病人中央区淋巴结的清扫数及阳性淋巴结的清扫数,有利于甲状腺癌的淋巴结清扫。
Objective: To investigate the clinical value of nanocarbon suspension tracer in lymph node dissection of cervical lymph node-negative (cN_0) thyroid papillary carcinoma. Methods: From September 2015 to June 2016, 85 patients with cN_0 thyroid papillary carcinoma treated in the Southeast Hospital of Shanghai Huangpu District were enrolled. 45 patients were randomly selected using carbon nanocarrier tracer (tracer group) and another 40 The patient did not use nanocarbon lymphatic tracer (control group). All patients underwent total thyroidectomy and ipsilateral or bilateral central lymph node dissection, compared the number of lymph node dissection in both groups and lymph node metastasis. Results: The total number of lymph nodes in tracer group and control group were 294 and 116, respectively. In the tracer group, the central lymph nodes (6.5 ± 5.3) were significantly higher than those in the control group (2.9 ± 2.2) (P <0.001). The lymph node metastasis rate in tracer group was 37.8% (17/45) and 45.0% (18/40) in control group, with no significant difference (P = 0.499). Positive lymph nodes in the tracer group and control group were (1.2 ± 2.2) and (0.7 ± 0.8), respectively, with no significant difference (P = 0.119). Among patients with lymph node metastasis, the numbers of lymph nodes in the tracer group were more than those in the control group (P = 0.007). Two groups of patients were followed up for 6 months, found no tumor recurrence, metastasis and death. Conclusion: Nanocarbon lymphadenectomy can significantly improve the number of lymph nodes and the number of positive lymph nodes in the central area of patients with cN_0 thyroid papillary carcinoma, which is good for lymph node dissection of thyroid cancer.