摘要
【目的】探讨纳米炭混悬液在分化型甲状腺癌合并其他甲状腺疾病行颈中央区淋巴清扫中的示踪效果差异。【方法】回顾性分析2015年7月至2019年7月梅州市人民医院收治的分化型甲状腺癌患者共500例,将患者分为纳米炭组(A组)314例及非纳米炭组(B组)186例,并根据无合并疾病(亚组0)、合并多结节性甲状腺肿(亚组1)、合并桥本氏甲状腺炎(亚组2)或甲状腺癌灶较大(肿瘤最大径超过30 mm,亚组3),进一步将A、B两组分成4个亚组,比较各组的淋巴结检获数及术后并发症的发生情况。【结果】A组的淋巴结检获数和转移率均多于B组[6.0(3.0~9.0)vs.3.0(1.0~5.3),P<0.001;24.4%vs.20.7%,P=0.041)];A0组、A1组、A2组的淋巴结检获数均多于B0[8.0(6.0~11.0)vs.3.0(2.0~6.0),P<0.001)]、B1[4.0(3.0~6.8)vs.3.0(0.0~5.0),P<0.001)]、B2[8.0(5.0~12.0)vs.4.0(0.0~6.5),P=0.002]组。同为术中使用纳米炭,A1、A3组的淋巴结检获数显著少于A0组[4.0(3.0~6.8)vs.8.0(6.0~11.0),P<0.001;3.0(2.0~6.0)vs.8.0(6.0~11.0),P<0.001)];A1、A2、A3组和A0组相比,声嘶的发生率均无统计学意义(P>0.05),A2、A3组术后甲状旁腺功能减退的发生率显著高于A0组(51.8%vs.34.1%,P<0.05;54.2%vs.34.1%,P<0.05)。【结论】分化型甲状腺癌术中应用纳米炭可提高淋巴结的检获数,无合并疾病的作用效果最佳,合并多结节性甲状腺肿、癌灶过大可影响纳米炭的示踪效果,当癌灶最大径大于30 mm时应用纳米炭对淋巴结的检出无明显作用。
【Objective】To investigate the tracer effect of carbon nanoparticle suspension in central neck lymph node dissection of differentiated thyroid cancer with other thyroid diseases.【Methods】A total of 500 patients with differentiated thyroid cancer hospitalized in Meizhou People′s Hospital from July 2015 to July 2019 were retrospectively analyzed.Patients were divided into carbon nanoparticles group(group A,314 cases)and non-carbon nanoparticles group(group B,186 cases).Group A and B were further divided into 4 subgroups according to the classifications of no other disease(subgroup 0),with nodular goiter(subgroup 1),with Hashimoto′s thyroiditis(subgroup 2)and large tumor(the diameter>30 mm,subgroup 3),and the number of lymph nodes dissected in each group and the incidence of complications were analyzed.【Results】The number of lymph nodes harvested and metastasis rate in group A was higher than that in group B[6.0(3.0~9.0)vs.3.0(1.0~5.3),P<0.001;24.4%vs.20.7%,P=0.041)].The number of lymph nodes harvested in group A0,A1 and A2 was higher than that in group B0[8.0(6.0~11.0)vs.3.0(2.0~6.0),P<0.001)],B1[4.0(3.0~6.8)vs.3.0(0.0~5.0),P<0.001)]andB2[8.0(5.0~12.0)vs.4.0(0.0~6.5),P=0.002].The number of lymph nodes harvested in group A1 and A3 was significantly lower than that in group A0[4.0(3.0~6.8)vs.8.0(6.0~11.0),P < 0.001;3.0(2.0 ~ 6.0)vs. 8.0(6.0 ~ 11.0),P < 0.001)]. The incidence of hoarseness in group A1,A2 and A3 wascomparable with that in group A0(P > 0.05),and the incidence of postoperative parathyroid dysfunction in group A2 andA3 was significantly higher than that in group A0(51.8% vs. 34.1%,P < 0.05;54.2% vs. 34.1%,P < 0.05).【Conclusions】The application of carbon nanoparticles in the operation of differentiated thyroid cancer increases the number of lymphnodes harvested,and the best effect is without complicated diseases. The tracking effect of carbon nanoparticles is affect⁃ed by the combination of nodular goiter. When the maximum diameter of the tumor is greater than 30 mm,it has no obvi⁃ou
作者
曾庆欣
王悦冬
钟海烽
赖烨钤
古逸骅
ZENG Qing-xin;WANG Yue-dong;ZHONG Hai-feng;LAI Ye-qian;GU Yi-hua(Department of Thyroid Surgery,Meizhou People′s Hospital/Meizhou Hospital Affiliated to Sun Yat-sen University,Meizhou 514031,China)
出处
《中山大学学报（医学科学版）》
CAS
CSCD
北大核心
2020年第6期951-958,共8页
Journal of Sun Yat-Sen University:Medical Sciences
基金
梅州市社会发展科技计划项目(2019B003)。
关键词
分化型甲状腺癌
纳米炭
甲状腺
淋巴结清扫
differentiated thyroid cancer(DTC)
carbon nanoparticles
thyroid
lymph node dissection
