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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) ›› 2020, Vol. 14 ›› Issue (04) : 420 -423. doi: 10.3877/cma.j.issn.1674-3946.2020.04.029

所属专题： 文献；

论著

纳米炭淋巴示踪剂在cN0期甲状腺微小乳头状癌的应用效果研究
尚兴国1,†(), 张雪棉2, 岳秀杰3, 杨东4, 马英桥5   
  1. 1. 066000　河北省秦皇岛市第四医院头颈外科
    2. 066000　河北省秦皇岛市第三医院超声科
    3. 066000　河北省秦皇岛市第四医院病理科
    5. 066000　河北省秦皇岛市第四医院超声科
  • 收稿日期:2019-09-02 出版日期:2020-08-26
  • 通信作者: 尚兴国

Preliminary study of lymphatic tracer in the surgery of cN0 thyroid micropapillary carcinoma

Xingguo Shang1,†(), Xuemian Zhang2, Xiujie Yue3, Dong Yang4, Yingqiao Ma5   

  1. 1. Department of Head and Neck Surgery, Fourth Hospital of Qinhuangdao City, Qinhuangdao City, Hebei Province 066000, China
    2. Department of Ultrasound, Qinhuangdao Third Hospital, Qinhuangdao City, Hebei Province 066000, China
    3. Department of Pathology, Fourth Hospital of Qinhuangdao City, Qinhuangdao City, Hebei Province 066000, China
    4. Department of Ultrasound, Fourth Hospital of Qinhuangdao, Qinhuangdao City, Hebei Province 066000, China
  • Received:2019-09-02 Published:2020-08-26
  • Corresponding author: Xingguo Shang
  • About author:
    Corresponding author: Shang Xingguo, Email:
  • Supported by:
    Qinhuangdao City-level Science and Technology Plan Project(201805A029)
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引用本文：

尚兴国, 张雪棉, 岳秀杰, 杨东, 马英桥. 纳米炭淋巴示踪剂在cN0期甲状腺微小乳头状癌的应用效果研究[J]. 中华普外科手术学杂志(电子版), 2020, 14(04): 420-423.

Xingguo Shang, Xuemian Zhang, Xiujie Yue, Dong Yang, Yingqiao Ma. Preliminary study of lymphatic tracer in the surgery of cN0 thyroid micropapillary carcinoma[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2020, 14(04): 420-423.

目的

探讨淋巴示踪剂用于cN0期甲状腺微小乳头状癌(PTMC)的手术指导及对术后复发风险预警的效果。

方法

选取2018年1月至2018年12月进行手术的cN0期PTMC 106例作为研究对象，按照随机数字表法1：1分为常规组(53例)和示踪组(53例)，示踪组术中采取淋巴示踪剂进行中央区淋巴结清扫，常规组未使用淋巴示踪剂，应用SPSS19.0软件进行分析，淋巴结切除平均数和转移平均数以(±s)显示，采取独立t检验；术后并发症行χ2检验；进行单因素方差分析、多因素logistic回归分析；P<0.05差异具有统计学意义。

结果

示踪组淋巴结切除平均数和淋巴结转移平均数明显高于常规组(P<0.05)；但两组淋巴结转移例数差异无统计学意义(P>0.05)。多因素结果提示，年龄≥45岁、肿瘤大小≥0.5 cm、肿瘤突破被膜是影响cN0甲状腺微小乳头状癌淋巴结转移的独立因素(P<0.05)。示踪组与常规组术后低钙血症发生率比较(3.77% vs. 16.98%)，差异有统计学意义(P<0.05)。示踪组无复发，常规组1例患者复发。

结论

应用淋巴示踪剂能提高cN0期PTMC患者淋巴结检出率；同时年龄、肿瘤大小、肿瘤是否突破被膜是影响cN0期PTMC患者淋巴结转移的独立因素。

关键词: 甲状腺肿瘤, 癌，乳头状, 纳米管，碳, 复发, 淋巴转移
Objective

To investigate the surgical guidance of lymphatic tracer for detecting cN0 thyroid micropapillary carcinoma (PTMC) and its effect on warning of recurrence risk.

Methods

A total of 106 patients with cN0 PTMC who underwent surgery in the Fourth Hospital of Qinhuangdao from January 2018 to December 2018 were enrolled. According to random number table method, the patients were divided into regular group (n=53) and the tracking group (n=53), lymphatic tracer was used in the tracking group for intraoperative lymph node dissection, the regular group did not use lymphatic tracer. The factors associated with lymph node metastasis, postoperative complications, and relationship between recurrence and lymphatic tracer application were analyzed.Spss19.0 software was used for analysis, the average number of lymph node resection and metastasis (±s) was compared with independent t-test was used; postoperative complications were compared with χ2 test; single factor analysis of variance and multivariate logistic regression analysis were used; the difference was statistically significant (P<0.05).

Results

The average number of lymph node resection and lymph node metastasis in the tracer group was significantly higher than that in the regular group (P<0.05), but the cases of lymph node metastasis had no significantly difference (P>0.05). The results showed that age ≥ 45 years old, tumor size ≥ 0.5cm and tumor breaking through the capsule were independent factors affecting lymph node metastasis of cN0 thyroid micro papillary carcinoma (P<0.05). Postoperative hypocalcemia was compared between the two groups (3.77% vs. 16.98%), and the difference was statistically significant (P<0.05) .There was no recurrence in the tracking group and 1 patient in the regular group relapsed.

Conclusion

Lymphatic tracer can improve the detection rate of lymph nodes in patients with PTMC at cN0 stage, and age, tumor size and whether the tumor breaks through the capsule are independent factors affecting the lymph node metastasis in patients with PTMC at cN0 stage.

Key words: Thyroid neoplasms, Carcinoma, papillary, Nanotubes, carbon, Recurrence, Lymphatic metastasis
表1 106例PTMC患者术中是否使用示踪剂两组基线资料比较[(±s)，例]
组别 例数 性别 年龄(岁) 肿瘤直径(mm) 体重指数(kg/m2)
女/男
示踪组 53 37/16 42.37±7.79 7.38±1.84 22.37±3.28
常规组 53 38/15 43.21±6.95 7.21±1.56 23.49±2.91
t/χ2值 ? 0.046 0.586 0.513 1.860
P值 ? 0.831 0.559 0.609 0.066
图1 淋巴结示踪剂应用在甲状腺切除术中[A:淋巴结示踪剂染色后显露甲状腺及淋巴结；B：甲状腺切除术中甲状腺及淋巴结染成黑色；C：术后切除的甲状腺及淋巴结组织]
表2 106例PTMC患者术中是否使用示踪剂两组术后淋巴结检出情况对比(±s)
组别 例数 切除淋巴结总数(枚) 切除淋巴结平均数(枚) 淋巴结转移数[例(%)] 淋巴结转移平均数(枚)
示踪组 53 435 8.21±1.21 22(41.51) 3.64±0.43
常规组 53 346 6.53±1.03 20(37.73) 2.69±0.38
t/χ2值 ? ? 7.697 0.158 12.052
P值 ? ? 0.000 0.691 0.000
表3 106例PTMC患者术中是否使用示踪剂cN0期PTMC淋巴结转移单因素分析
因素 ? 未转移(n＝68) 转移(n＝38) χ2值 P值
性别 女 50 25 0.706 0.401
男 18 13
年龄 ≥45岁 26 23 4.873 0.027
<45岁 42 15
肿瘤数目 单个 47 20 2.849 0.091
多个 21 18
肿瘤大小 ≥0.5 cm 34 27 4.423 0.035
<0.5 cm 34 11
肿瘤部位 单侧 44 19 2.187 0.139
双侧 24 19
是否突破被膜 是 37 29 4.978 0.026
否 31 9
表4 106例PTMC患者术中是否使用示踪剂cN0期PTMC淋巴结转移多因素分析
因素 B Wald值 P值 OR值 95%CI
年龄(≥45岁、<45岁) 0.392 4.389 0.035 1.638 0.893～2.518
肿瘤大小(≥0.5 cm、<0.5 cm) 0.571 8.739 0.000 1.728 1.129～2.574
是否突破被膜(是、否) 0.684 5.025 0.027 2.375 1.318～3.476
表5 106例PTMC患者术中是否使用示踪剂两组并发症发生情况对比(例)
组别 例数 声音嘶哑(%) 低钙血症(%)
示踪组 53 13(24.53) 2(3.77)
常规组 53 14(26.43) 9(16.98)
t值/χ2值 ? 0.050 4.970
P值 ? 0.824 0.026
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