CAJ | 학술논문

目的探讨纳米碳在甲状腺癌手术中对颈部Ⅵ区淋巴清扫和甲状旁腺功能及喉返神经功能保护的价值.方法对同时实施甲状腺全切除及双侧Ⅵ区淋巴清扫的109例分化型甲状腺癌患者进行前瞻性分析.45例在术前实施甲状腺纳米碳注射和淋巴结显影(纳米碳组),64例行常规手术(对照组).对Ⅵ区清扫组织行单独病理检查,分别统计其淋巴结总数、淋巴结转移率、甲状旁腺显露数、甲状旁腺误切数、术后甲状旁腺激素水平及喉返神经功能.采用t检验或x2检验进行统计学分析.结果纳米碳组Ⅵ区淋巴结每侧检出(9.7±1.7)枚,对照组每侧检出(6.7±1.9)枚,两组差异有统计学意义(t=23.14,P＜O.001).纳米碳组淋巴结黑染率为90.5％(738/815),黑染淋巴结转移率为45.9％(339/738),非黑染淋巴结转移率为13.0％ (10/77),差异有统计学意义(x2=30.91,P＜0.001).纳米碳组平均每侧显露甲状旁腺(1.8±0.9)枚,误切率为5.9％ (5/84),对照组平均每侧显露甲状旁腺(1.8±1.0)枚,误切率为8.2％(11/134),两组差异均无统计学意义.术后ld、5d及30 d纳米碳组甲状旁腺激素值分别为7.30、11.19和30.5 ng/L,对照组分别为7.51、10.90和28.30 ng/L,两组间的时间点甲状旁腺激素值比较差异均无统计学意义.两组均无医源性永久喉返神经麻痹.结论纳米碳有助于提高甲状腺癌手术淋巴清扫的彻底性,但对保护甲状旁腺和喉返神经功能无肯定作用.
목적 탐토납미탄재갑상선암수술중대경부Ⅵ구림파청소화갑상방선공능급후반신경공능보호적개치.방법 대동시실시갑상선전절제급쌍측Ⅵ구림파청소적109례분화형갑상선암환자진행전첨성분석.45례재술전실시갑상선납미탄주사화림파결현영(납미탄조),64례행상규수술(대조조).대Ⅵ구청소조직행단독병리검사,분별통계기림파결총수、림파결전이솔、갑상방선현로수、갑상방선오절수、술후갑상방선격소수평급후반신경공능.채용t검험혹x2검험진행통계학분석.결과 납미탄조Ⅵ구림파결매측검출(9.7±1.7)매,대조조매측검출(6.7±1.9)매,량조차이유통계학의의(t=23.14,P＜O.001).납미탄조림파결흑염솔위90.5％(738/815),흑염림파결전이솔위45.9％(339/738),비흑염림파결전이솔위13.0％ (10/77),차이유통계학의의(x2=30.91,P＜0.001).납미탄조평균매측현로갑상방선(1.8±0.9)매,오절솔위5.9％ (5/84),대조조평균매측현로갑상방선(1.8±1.0)매,오절솔위8.2％(11/134),량조차이균무통계학의의.술후ld、5d급30 d납미탄조갑상방선격소치분별위7.30、11.19화30.5 ng/L,대조조분별위7.51、10.90화28.30 ng/L,량조간적시간점갑상방선격소치비교차이균무통계학의의.량조균무의원성영구후반신경마비.결론 납미탄유조우제고갑상선암수술림파청소적철저성,단대보호갑상방선화후반신경공능무긍정작용.
Objective To assess the efficiency of carbon nanoparticle in guiding level Ⅵ lymphadenectomy and parathyroid preservation in thyroidectomy for carcinoma.Methods One hundred and nine patients with well differentiated thyroid carcinoma,in whom thyroidectomy and bilateral lymphadenectomy for level Ⅵ were carried out at the same time,were prospectively studied.Fourty-five cases received carbon nanoparticle injecion in thyroid consistitued trial group,while sixty-four underwent conventional surgery as control group.The numbers of total dissected lymph nodes,metastasis lymph nodes,black-stained lymph nodes,detected parathyroids and mistakenly removed parathyroids were counted respectively.The PTH levels were measured at 1 d,5 d and 30 d after surgery,respectively.Student's t test and Chi-square analysis were used for analyzing data.Results The number of lymph node found in the trial group in level Ⅵ was checked out as (9.7 ± 1.7) each side,whereas that of the control group was (6.7 ± 1.9) each side.The discrepancy of two groups was statistical meaningful (t =23.14,P ＜ 0.001).The discrepancy of the rate of lymph node black-stained 90.5％ (738/815),incidence of metastasis of the black-stained lymph nodes 45.9％ (339/738) and that without black-staining 13.0％ (10/77),was statistical meaningful(x2 =30.91,P ＜ 0.001).On average,the trial group showed(1.8 ± 0.9) parathyroid each side,and had 5.9％ (5/84) of mistakenly removed incidence,on contrary,the control group showed(1.8 ± 1.0) parathyroid each side,and had 8.2％ (11/134) of mistakenly removed incidence averagely as well.The discrepancy of two groups was statistical meaningful.In the trial group,the amount of PTH 1 d,5 d and 30 d postoperatively were 7.30,11.19 and 30.50 ng/L respectively,while that of the control group were 7.51,10.90 and 28.30 ng/L respectively.The amount discrepancy between the two groups was not differences.No permanent recurrent nerve paralysis was found in both groups.Conclusion Carbon nanoparticle may improve the detected rate of metastasis lymph nodes,but may not be helpful to the prevention of postoperative hypoparathyrosim.