纳米炭混悬液在腔镜甲状腺癌手术中的 应用

俞春亮 霍红军 李泽群




【摘要】 目的 研究纳米炭混悬液在腔镜甲状腺癌手术中的应用效果。方法 82例采取经乳晕入路腔镜甲状腺癌手术患者, 随机分为观察组(40例)和对照组(42例)。观察组在手术中应用纳米炭混悬液, 对照组在手术中未应用纳米碳混悬液。比较两组中央区淋巴结清扫数目、一过性低钙血症、暂时性甲状旁腺功能低下、永久性甲状旁腺功能低下、甲状旁腺误切发生情况。结果 观察组术后一过性低钙血症、暂时性甲状旁腺功能低下发生率与对照组比较差异无统计学意义(P>0.05);两组均未发生永久性甲状旁腺功能低下;观察组甲状旁腺误切发生率2.5%(1/40)明显低于对照组的19.1%(8/42), 中央区淋巴结清扫数目(6.0±2.0)枚明显多于对照组的(3.2±1.7)枚, 差异均有统计学意义(P<0.05)。结论 临床上在腔镜甲状腺癌手术中应用纳米炭混悬液对减少甲状旁腺误切、增加淋巴结清扫数目具有重要的意义, 值得临床推广。

【关键词】 纳米炭混悬液;腔镜甲状腺癌手术;甲状腺旁腺

DOI:10.14163/j.cnki.11-5547/r.2020.07.007

Application of nano-carbon suspension in the endoscopic surgery for thyroid cancer   YU Chun-liang, HUO Hong-jun, LI Ze-qun. Department of Thyroid and Breast Surgery, Longgang Central Hospital, Shenzhen 518116, China

【Abstract】 Objective   To study the application effect of nano-carbon suspension on parathyroid gland in the endoscopic surgery for thyroid cancer. Methods   A total of 82 patients undergoing laparoscopic approach for endoscopic thyroid cancer surgery were randomly divided into observation group (40 cases) and control group (42 cases). The observation group was treated with nano-carbon suspension during operation, while the control group was not treated with nano-carbon suspension during operation. The number of lymph node dissections in the central area, occurrence of transient hypocalcemia, temporary hypoparathyroidism, permanent hypoparathyroidism, and parathyroidectomy by mistake were compared between the two groups. Results   There was no significant difference in the incidence of transient hypocalcemia and temporary hypoparathyroidism between the observation group and the control group (P>0.05). There was no permanent hypoparathyroidism in both groups. The incidence of parathyroidectomy by mistake 2.5%(1/40) in the observation group was obviously lower than 19.1%(8/42) in the control group, and number of lymph node dissections in the central area (6.0±2.0) pieces was obviously more than (3.2±1.7) pieces in the control group. Their difference was statistically significant (P<0.05). Conclusion   The application of nano-carbon suspension in endoscopic surgery for thyroid cancer is of great significance to reduce the number of parathyroidectomy by mistake and increase the number of lymph node dissections. It is worthy of clinical promotion.

【Key words】 Nano-carbon suspension; Endoscopic surgery for thyroid cancer; Parathyroid gland

自1996年Hüscher 等[1]成功開展首例腔镜甲状腺腺叶切除术以来, 随着医疗技术的进步以及人们对美观要求的日益提高, 腔镜甲状腺手术已逐步成为甲状腺疾病的主要治疗术式之一。随着甲状腺疾病的发病率逐年增高, 与甲状腺关系密切的甲状旁腺损伤及相关并发症也较为常见。正因甲状旁腺与甲状腺关系密切以及甲状旁腺位置的相对不确定性, 在甲状腺手术时也出现了因甲状旁腺不同程度损伤所致的旁腺功能下降, 对患者的日常生活造成重大影响, 同时也给患者带来了重大的心理及经济负担, 因此探索一种腔镜甲状腺手术中有效减少旁腺损伤的方法就显得尤为重要。纳米炭混悬液具有高度的淋巴系统趋向性[2], 其作为一种淋巴示踪剂, 最近已被广泛应用于甲状腺外科手术。纳米炭混悬液注射到组织内可迅速进入淋巴管道, 滞留、聚集在淋巴结, 使淋巴结黑染。甲状旁腺不接纳甲状腺的淋巴回流, 纳米炭混悬液亦不进入血管, 因此在甲状腺注射纳米炭后, 甲状腺、颈部淋巴管及淋巴结都会被黑染, 而甲状旁腺不会被黑染, 称之为甲状旁腺“负显影”[3], 使之与被黑染的甲状腺及淋巴结容易区分, 从而使术中能够准确的辨识出甲状腺旁腺, 从而加强对其保护。收集2016年8月~2018年5月本院82例采取经乳晕入路腔镜甲状腺癌手术患者, 术中使用纳米炭混悬液对甲状旁腺进行“负显影”, 精准辨识出甲状旁腺, 通过精细的被膜解剖技术, 从而加强对甲状旁腺的保护, 取得了满意的效果。现将结果报告如下。

综上所述, 临床上在腔镜甲状腺癌手术中应用纳米炭混悬液对减少甲状旁腺误切、增加淋巴结清扫数目具有重要的意义, 值得临床推广。

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[收稿日期:2019-12-18]

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