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中华普外科手术学杂志(电子版)

中华普外科手术学杂志(电子版) ›› 2018, Vol. 12 ›› Issue (04) : 302 -305. doi: 10.3877/cma.j.issn.1674-3946.2018.04.011

所属专题： 文献；

论著

纳米碳在甲状腺微小乳头状癌手术中对甲状旁腺及喉返神经的保护作用研究
孙荣能1, 赵迎春1,†(), 曹晓丽1   
  1. 1. 241000　安徽，芜湖市第二人民医院甲乳外科
  • 收稿日期:2018-03-08 出版日期:2018-08-26
  • 通信作者: 赵迎春

Protective effect of nano-carbon on parathyroid gland and recurrent laryngeal nerve in papillary thyroid micro-carcinoma surgery

Rongneng Sun1, Yingchun Zhao1,†(), Xiaoli Cao1   

  1. 1. Department of thyroid gland and Breast surgery, the second people’s Hospital of Wuhu City, the second people’s hospital of Wuhu city 241000
  • Received:2018-03-08 Published:2018-08-26
  • Corresponding author: Yingchun Zhao
  • About author:
    Corresponding author: Zhao Yingchun, Email:
  • Supported by:
    Project of Science and Technology plan 2015 of Wuhu City, Anhui 241000(NO.2015hm07)
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孙荣能, 赵迎春, 曹晓丽. 纳米碳在甲状腺微小乳头状癌手术中对甲状旁腺及喉返神经的保护作用研究[J]. 中华普外科手术学杂志(电子版), 2018, 12(04): 302-305.

Rongneng Sun, Yingchun Zhao, Xiaoli Cao. Protective effect of nano-carbon on parathyroid gland and recurrent laryngeal nerve in papillary thyroid micro-carcinoma surgery[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2018, 12(04): 302-305.

目的

探讨纳米碳在甲状腺微小乳头状癌手术中对甲状旁腺及喉返神经的保护作用。

方法

选取2015年6月至2017年5月行甲状腺微小乳头状癌手术的患者共67例作为本次研究对象，随机将67例患者分为纳米碳组(33例)和常规手术组(34例)，常规手术组患者行常规手术治疗，纳米碳组患者术中加用纳米碳示踪剂。使用统计学软件SPSS19.0分析，术中术后指标，术前术后甲状旁激素、血钙水平变化以(±s)表示，采用独立t检验；术后并发症发生率，采用卡方检验，以P < 0.05为差异有统计学意义。

结果

两组患者术中出血量、手术时间、康复出院时间及甲状旁腺误切率(3.0%比32.4%)比较，纳米碳组均低于常规手术组(P<0.05)，两组患者Ⅵ区淋巴结清扫数目、Ⅵ区淋巴结转移情况比较差异无统计学意义(P>0.05)；两组患者术前甲状旁激素、血钙水平比较无差异(P>0.05)，术后3 d内纳米碳组甲状旁激素、血钙水平明显高于常规手术组(P<0.05)，术后7 d两组差异无统计学意义(P>0.05)；纳米碳组患者术后声音嘶哑、自感发声无力、暂时性低血钙等并发症发生率明显低于常规手术组(P<0.05)，术后3、6个月复查肿瘤病灶复发率纳米碳组低于常规手术组，但差异无统计学意义(P>0.05)。

结论

在甲状腺微小乳头状癌手术中使用纳米碳可清楚鉴别甲状旁腺和淋巴结，对保护甲状旁腺和周围正常组织有重要意义，值得推广。

关键词: 甲状腺肿瘤, 癌，乳头状, 纳米管，碳, 甲状旁腺, 喉返神经
Objective

To investigate the protective effect of nano carbon on parathyroid gland and recurrent laryngeal nerve in papillary thyroid micro-carcinoma surgery.

Methods

A total of 67 patients with papillary thyroid micro-carcinoma from June 2015 to May 2017 were enrolled into this study. 67 patients, who were randomly divided into nanometer carbon group (n=33) and routine operation group (n=34). The changes of parathyroid hormone, serum calcium level and postoperative complications were observed in both χ2 groups. Statistical analysis were performed by using SPSS 19.0 software. Perioperative measurement data, such as parathyroid hormones and serum calcium levels were expressed as (±s), and were examined by using t test.The postoperative complication rate was analyzed by Chi-square test. A P value <0.05 was considered as statistically significant difference.

Results

The intraoperative blood loss, operation time, recovery and discharge time and parathyroid miscut rate were significantly lower in nano-carbon group than those in routine operation group (P<0.05), and the Number of lymph node dissection in VI region of two groups was lower than that in conventional operation group. There was no significant difference in lymph node metastasis between two groups (P>0.05), there was no significant difference in terms of serum calcium and parathyroid hormone levels between two groups before operation (P>0.05), and within 3 days after operation, parathyroid hormone was found in the nano-carbon group. The level of serum calcium in routine operation group was significantly higher than that in routine operation group (P<0.05), and gradually recovered in routine operation group 7 days after operation, and there was no difference compared with nano-carbon group (P>0.05). The incidence of postoperative complications such as hoarseness, spontaneous voice weakness and transient hypocalcemia in the carbon group was significantly lower than those in the routine operation group (P<0.05). The recurrence rate of tumor focus in nano-carbon group was lower than that in conventional operation group 3 and 6 months after operation, with no significant difference (P>0.05).

Conclusion

Nano carbon could be used to distinguish parathyroid gland and lymph node clearly in thyroid micropapillary carcinoma surgery. It is important to protect parathyroid gland and surrounding normal tissue and is worth popularizing.

Key words: Thyroid Neoplasms, Carcinoma, Papillary, Nanotubes, Carbon, Parathyroid Glands, Recurrent Laryngeal Nerve
表1 67例PTMC患者不同疗法两组患者一般资料比较(例)
组别 例数 女 年龄(±s，岁) 切除部位 肿瘤大小(±s，mm)
双叶 腺叶加峡部 单侧颈
纳米碳组 33 23 48.0±3.5 23 7 3 9.1±1.3
常规组 34 27 47.8±3.8 22 8 4 8.7±1.8
t/χ2值 ? 1.775 0.225 1.313 1.031
P值 ? 0.184 0.823 0.188 0.168
表2 67例PTMC患者不同疗法两组患者手术各指标比较(±s)
组别 例数 淋巴结清扫数目(枚) 术中出血量(ml) 手术时间(min)
纳米碳组 33 4.6±2.2 14.3±3.2 84.3±9.8
常规组 34 3.6±2.1 21.8±3.0 105.3±11.6
t/χ2值 ? 0.445 5.327 8.009
P值 ? 0.658 0.000 0.000
组别 例数 出院时间(d) 淋巴结转移[例(%)] 误切率[例(%)]
纳米碳组 33 7.0±1.8 20(60.6) 1(3.0)
常规组 34 10.7±2.1 18(52.9) 11(32.4)
t/χ2值 ? 3.657 1.401 9.793
P值 ? 0.001 0.527 0.000
表3 67例PTMC患者不同疗法患者术后甲状旁激素检测结果(±s, pg/ml)
组别 例 术前 术后1 d 术后2 d 术后3 d
纳米碳组 33 21.3±5.7 20.3±5.8 21.2±5.9 22.3±4.9
常规组 34 21.0±5.9 8.9±2.2 9.9±2.8 13.0±4.0
t值 ? 0.829 10.694 10.126 6.445
P值 ? 0.480 0.000 0.000 0.000
表4 67例PTMC患者不同疗法两组患者术前术后血钙水平比较结果(±s, mmol/L)
组别 例 术前 术后1d 术后3d 术后7d
纳米碳组 33 2.2±0.2 2.2±0.3 2.0±0.3 2.1±0.2
常规组 34 2.3±0.2 1.9±0.6 1.7±0.2 1.9±0.6
t值 ? 0.742 2.760 4.585 1.904
P值 ? 0.460 0.038 0.000 0.054
表5 67例PTMC患者不同疗法两组患者术后复发率及并发症发生率比较[例(%)]
组别 例数 声音嘶哑 自感发声无力 暂时性低血钙 3个月复发率 6个月复发率
纳米碳组 33 4(12.1) 3(9.1) 3(9.1) 1(3.0) 1(3.0)
常规组 34 12(35.3) 11(32.3) 12(35.3) 2(6.1) 3(8.8)
χ2值 ? 4.947 5.482 6.617 1.034 1.521
P值 ? 0.026 0.019 0.010 0.224 0.168
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