CAJ | 학술논문

目的探讨纳米碳在甲状腺癌行甲状腺全切加双侧中央区清扫中对淋巴结处理及保护甲状旁腺中的作用.方法 2008年4月至2013年5月初治的86例行甲状腺全切加双侧中央区清扫的甲状腺癌患者随机分为试验组(43例)和对照组(43例).试验组在甲状腺注入纳米碳,计数试验组清扫标本的淋巴结总数、转移数、黑染数及黑染转移数,计数对照组清扫标本的淋巴结总数、转移数,在两组标本中检查有无甲状旁腺.检测两组术前及术后第1、3、5天及第1、3、6个月的血钙及甲状旁腺素水平.本研究通过河北医科大学第四医院伦理委员会批准.结果试验组平均每例检出淋巴结(10.19±4.27)枚及黑染淋巴结(8.44±4.31)枚,均高于对照组检出的淋巴结数[(6.26±2.98)枚](均P＜0.01).对照组清扫组织中有11例检出甲状旁腺,试验组7例,两组差异无统计学意义(x2=1.124,P=0.289).两组术后6个月内所测的血钙及甲状旁腺素水平均小于术前(均P＜0.01).包膜无外侵时,试验组甲状旁腺素及血钙水平在术后第5天、1个月及3个月的值高于对照组(均P＜0.05).有淋巴结转移的患者,术后1个月试验组所测的甲状旁腺素(t=2.441,P=0.017)及血钙(t =3.446,P=0.001)水平均高于对照组.包膜外侵或者无淋巴结转移时,两组术后6个月内的甲状旁腺素及血钙水平差异均无统计学意义(均P ＞0.05).原发灶≤4 cm时,试验组术后1个月时的甲状旁腺素水平高于对照组(t=2.703,P=0.009),＞4 cm时两组术后6个月内的甲状旁腺素水平差异均无统计学意义(均P ＞0.05).无论原发灶＞4 cm或≤4 cm,术后1个月试验组所测的血钙水平均高于对照组(均P＜0.01).结论甲状腺注入纳米碳,可以提高术中阳性淋巴结的检出率;在无包膜外侵或是伴有淋巴结转移的情况下,纳米碳可以较好地保护甲状旁腺功能.
목적 탐토납미탄재갑상선암행갑상선전절가쌍측중앙구청소중대림파결처리급보호갑상방선중적작용.방법 2008년4월지2013년5월초치적86례행갑상선전절가쌍측중앙구청소적갑상선암환자수궤분위시험조(43례)화대조조(43례).시험조재갑상선주입납미탄,계수시험조청소표본적림파결총수、전이수、흑염수급흑염전이수,계수대조조청소표본적림파결총수、전이수,재량조표본중검사유무갑상방선.검측량조술전급술후제1、3、5천급제1、3、6개월적혈개급갑상방선소수평.본연구통과하북의과대학제사의원윤리위원회비준.결과 시험조평균매례검출림파결(10.19±4.27)매급흑염림파결(8.44±4.31)매,균고우대조조검출적림파결수[(6.26±2.98)매](균P＜0.01).대조조청소조직중유11례검출갑상방선,시험조7례,량조차이무통계학의의(x2=1.124,P=0.289).량조술후6개월내소측적혈개급갑상방선소수평균소우술전(균P＜0.01).포막무외침시,시험조갑상방선소급혈개수평재술후제5천、1개월급3개월적치고우대조조(균P＜0.05).유림파결전이적환자,술후1개월시험조소측적갑상방선소(t=2.441,P=0.017)급혈개(t =3.446,P=0.001)수평균고우대조조.포막외침혹자무림파결전이시,량조술후6개월내적갑상방선소급혈개수평차이균무통계학의의(균P ＞0.05).원발조≤4 cm시,시험조술후1개월시적갑상방선소수평고우대조조(t=2.703,P=0.009),＞4 cm시량조술후6개월내적갑상방선소수평차이균무통계학의의(균P ＞0.05).무론원발조＞4 cm혹≤4 cm,술후1개월시험조소측적혈개수평균고우대조조(균P＜0.01).결론 갑상선주입납미탄,가이제고술중양성림파결적검출솔;재무포막외침혹시반유림파결전이적정황하,납미탄가이교호지보호갑상방선공능.
Objective To evaluate the role of carbon nanoparticles for dissecting lymph nodes and preserving parathyroid glands in patients with thyroid carcinoma undergoing total thyroidectomy plus bilateral central neck dissection.Methods A total of 86 patients with thyroid carcinoma undergoing primarily total thyroidectomy plus bilateral central neck dissection were randomly divided into trial and control groups.Carbon nanoparticles were injected into thyroid gland of trial group.Total lymph node,metastasis lymph node,black stained lymph node and black stained metastasis lymph node of trial group were counted in central compartment dissection specimens.And total lymph node and metastasis lymph node of control group were counted in central compartment dissection specimens.Parathyroid glands in central neck dissection specimens were counted in two groups.For two groups,serum total calcium and parathyroid hormone were measured pre-operation and 1 day,3 days,5 days,1 month,3 months and 6 months post-operation.Results In trial group,the average counts of (10.19 ±4.27) lymph nodes and (8.44 ±4.31) black stained lymph nodes were more than those in control group at (6.26 ± 2.98) lymph nodes (all P ＜ 0.01).Parathyroid gland was found in trial group (n =7) and control group (n =11).And the difference had no statistical significance (x2 =1.124,P =0.289).The preoperative serum levels of calcium and parathyroid hormone decreased within 6 months postoperatively in both groups (all P ＜ 0.01).Without extracapsular invasion,serum levels of calcium and parathyroid hormone were higher in trial group than those in control group at 5 days,1 month and 3 months post-operation (all P ＜ 0.05).In an event of lymph node metastasis,serum levels of calcium (t =3.446,P =0.001) and parathyroid hormone (t =2.441,P =0.017) in trial group were higher than those in control group at 1 month post-operation.When there was extracapsular invasion or no lymph node metastasis,the serum levels of calcium and parathyroid hormone had no inter-group statistical differences within 6 months post-operation (all P ＞ 0.05).When tumor size was less than or equal to 4 cm,the level of parathyroid hormone was higher in trial group than that in control group at 1 month post-operation (t =2.703,P =0.009).But no inter-group statistical differences existed within 6 months post-operation (all P ＞ 0.05) when tumor size surpassed 4 cm.Regardless of tumor size,the serum levels of calcium in trial group were higher than those in control group at 1 month post-operation (all P ＜ 0.01).Conclusions For thyroid carcinoma patients,total thyroidectomy plus bilateral central neck dissection increases the incidence of hypoparathyroidism.Lymph nodes of central compartment may be tagged by carbon nanoparticles so as to boost the detection rate of lymph node.In events of lymph node metastasis or no extracapsular invasion,carbon nanoparticles can adequately protect parathyroid functions.