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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 (05) : 517 -521. doi: 10.3877/cma.j.issn.1674-3946.2020.05.024

所属专题： 文献；

论著

纳米碳示踪剂用于cN0T1/T2期甲状腺乳头状癌中央区淋巴结清扫的效果及影响因素
龚勤俭1, 张莹华1, 杨再军1, 马洁1, 李志辉2,†()   
  1. 1. 642300　四川安岳县，资阳市安岳县人民医院乳腺甲状腺外科
    2. 610061　成都，四川大学华西医院
  • 收稿日期:2020-02-15 出版日期:2020-10-26
  • 通信作者: 李志辉

Effect and influencing factors of nano-carbon tracer on lymph node dissection in central area of cN0T1/T2 stage papillary thyroid carcinoma

Qinjian Gong1, Yinghua Zhang1, Zaijun Yang1, Jie Ma1, Zhihui Li2,†()   

  1. 1. Department of Breast and Thyroid Surgery, Anyue County People’s Hospital, Anyue 642300, China
    2. West China Hospital, Sichuan University, Chengdu 610061, China
  • Received:2020-02-15 Published:2020-10-26
  • Corresponding author: Zhihui Li
  • About author:
    Corresponding author: LI Zhihui, Email:
  • Supported by:
    Subsidized Project by Sichuan Health and Planning Commission(17JP111)
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引用本文：

龚勤俭, 张莹华, 杨再军, 马洁, 李志辉. 纳米碳示踪剂用于cN0T1/T2期甲状腺乳头状癌中央区淋巴结清扫的效果及影响因素[J]. 中华普外科手术学杂志(电子版), 2020, 14(05): 517-521.

Qinjian Gong, Yinghua Zhang, Zaijun Yang, Jie Ma, Zhihui Li. Effect and influencing factors of nano-carbon tracer on lymph node dissection in central area of cN0T1/T2 stage papillary thyroid carcinoma[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2020, 14(05): 517-521.

目的

探讨纳米碳示踪剂应用于cN0T1/T2期甲状腺乳头状癌中央区淋巴结清扫的效果及影响因素。

方法

选择2015年1月至2017年12月期间接受手术治疗的cN0T1/T2期甲状腺乳头状癌患者153例作为研究对象，随机数字表法分为踪剂组(76例)和常规组(77例)，其中踪剂组接受术中注射纳米碳示踪剂并进行中央区淋巴结清扫，常规组接受常规中央区淋巴结清扫。采用SPSS 21.0进行临床数据分析，围术期指标及淋巴结清扫数量等计量资料用(±s)表示，独立t检验；术后并发症、复发率采用χ2检验；预后情况绘制kaplanmeier生存曲线，对淋巴结检出因素进行单因素和多因素logistic回归分析，P<0.05差异有统计学意义。

结果

踪剂组人均清扫淋巴结数量为(9.3±2.3)枚、淋巴结检出阳性率95.1%，均明显优于常规组(P<0.05)。踪剂组在术后1 d、3 d、术后3个月血钙和PTH水平，明显高于常规组(P<0.05)。踪剂组甲状旁腺受损情况明显低于常规组(P<0.05)；两组在喉返神经损伤情况比较，差异无统计学意义(P>0.05)。踪剂组复发率(15.8%)明显低于常规组(29.9%), P<0.05。两组组内复发与未复发患者淋巴结清扫数量比较，差异均具有统计学意义(P<0.05)。所有患者的24个月总生存率为91.5%，不同淋巴结清扫数量与生存预后无相关性。体重指数、淋巴结平均直径、医师经验是纳米碳示踪剂检出淋巴结清扫数量的独立危险因素(P<0.05)。

结论

纳米碳示踪剂能够明显增加cN0T1/T2期甲状腺乳头状癌中央区淋巴结清扫数量，同时对预防手术并发症及术后复发有积极作用。

关键词: 甲状腺肿瘤, 癌，乳头状, 纳米管，碳, 淋巴转移, 淋巴结切除术, cN0T1/T2期
Objective

To investigate the effect and influencing factors of nano-carbon tracer on lymph node dissection in the central area of cN0T1/T2 stage papillary thyroid carcinoma.

Methods

153 patients with cN0T1 / T2 stage thyroid papillary carcinoma who underwent surgical treatment from January 2015 to December 2017 were selected as the research subjects. The random number table method was used to divide the tracer group (76 cases) and the routine group (77 cases)by 1∶1 ratio, the tracer group received intraoperative injection of nano-carbon tracer and central lymph node dissection, but the routine group received routine central lymph node dissection only. SPSS 21.0 were used for clinical data analysis. Measurement data such as perioperative indicators and number of lymph node dissections were expressed as (±s), and compared with independent t test; postoperative complications and recurrence rate were measured by χ2 tests; prognosis was plotted by kaplanmeier survival Curve, the univariate and multivariate logistic regression analysis was used for the detected factors of lymph nodes, P<0.05 was statistically significant.

Results

The number of lymph nodes per person in the tracer group was (9.3±2.3), and the positive rate of lymph node detection was 95.1%, which were significantly better than those in the routine group (P<0.05). The serum calcium and PTH levels in the tracer group were significantly higher than the routine group at 1 and 3 days and 3 months after surgery (P<0.05). The damage of the parathyroid glands in the tracer group was significantly lower than that in the conventional group (P<0.05). The relapse rate in the tracer group (15.8%) was significantly lower than the routine group (29.9%), and the difference was statistically significant (P<0.05). The 24-month overall survival rate of all patients was 91.5%. There was no significant difference in survival prognosis between different numbers of lymph node dissections (P<0.05). Multivariate logistic regression analysis showed, mean lymph node diameter, and physician experience were independent risk factors for the number of lymph node dissections detected by nano-carbon tracers (P<0.05).

Conclusion

Nano-carbon tracer can significantly increase the number of lymph node dissections in the central area of cN0T1/T2 stage papillary thyroid carcinoma, and it has a positive effect on the prevention of surgical complications and postoperative recurrence.

Key words: Thyroid neoplasms, Carcinoma, papillary, Nanotubes, carbon, Lymphatic metastasis, Lymph node excision, cN0T1/T2 stage
图1 153例cN0T1/T2期PTC患者研究路线图
表1 153例PTC患者术中不同淋巴结清扫方式两组患者基线资料对比[(±s)，例]
例数 例数 性别(男/女) 年龄(岁) 体重指数(kg/m2) 肿瘤直径(cm)
踪剂组 76 31/45 48.3±9.8 23.6±6.5 1.6±0.4
常规组 77 30/47 47.8±10.2 23.4±5.8 1.5±0.4
统计值 ? 0.053 0.302 0.201 0.894
P值 ? 0.817 0.763 0.841 0.373
表2 153例PTC患者术中不同淋巴结清扫方式两组围术期指标对比(±s)
组别 例数 手术时间(min) 住院时间(d) 术中出血量(ml) 引流量(ml)
踪剂组 76 112.6±21.3 6.5±1.7 53.4±12.5 37.4±8.7
常规组 77 114.2±24.5 7.0±2.1 52.1±11.3 36.4±8.2
统计值 ? 0.435 1.358 0.666 0.756
P值 ? 0.664 0.176 0.507 0.451
表3 153例PTC患者术中不同淋巴结清扫方式两组淋巴结清扫情况(例)
组别 例数 淋巴结检出阳性率(%) 人均清扫淋巴结数量(枚)
踪剂组 76 713/749(95.1) 9.3±2.3
常规组 77 524/671(78.0) 6.8±1.7
统计值 ? 92.199 7.641
P值 ? 0.000 0.000
图2 153例PTC患者术中不同淋巴结清扫方式两组术前术后血钙变化
图3 153例PTC患者术中不同淋巴结清扫方式两组术前术后PTH变化
表4 153例PTC患者术中不同淋巴结清扫方式两组并发症发生率比较[例(%)]
组别 例 喉返神经损伤 甲状旁腺损伤
踪剂组 76 2(2.6) 21(27.6)
常规组 77 4(5.1) 34(44.1)
χ2值 ? 0.667 4.536
P值 ? 0.414 0.033
表5 153例PTC患者术中不同淋巴结清扫方式两组术后复发情况(±s)
组别 例 复发例数(%) 复发淋巴结清扫数量 未复发淋巴结清扫数量 相关系数 P值
踪剂组 76 12(15.8)a 5.7±1.5b 10.0±2.7a 0.501 0.000
常规组 77 23(29.9) 4.7±1.2b 7.7±2.1 0.531 0.000
统计值 ? 4.298 12.155 5.886 ? ?
P值 ? 0.038 0.000 0.000 ? ?
图4 153例PTC患者术中不同淋巴结清扫数量Kaplan-Meier生存曲线
表6 影响纳米碳示踪剂检出淋巴结数量的单、多因素分析结果
? 单因素分析
OR 95%CI P值
性别(男，女) 1.046 0.673～1.663 0.268
年龄(<50岁，≥50岁) 2.016 1.457～2.771 0.042
术前活检(有，无) 1.169 0.739～1.854 0.147
体重指数(<25 kg/m2，≥25 kg/m2) 2.281 1.653～3.054 0.022
肿瘤T分期(T1，T2) 1.228 0.549～2.158 0.096
手术时间(≤120 min，>120 min) 1.105 0.684～1.830 0.328
术中出血量(>50 ml，<50 ml) 0.847 0.369～1.562 0.117
淋巴结平均直径(<1 cm，≥1 cm) 2.368 1.226～3.694 0.032
医师经验(丰富，不丰富) 2.143 1.664～2.805 0.021
? 多因素分析
OR 95%CI P值
年龄(<50岁，≥50岁) 1.239 0.726～1.893 0.078
体重指数(<25 kg/m2，≥25 kg/m2) 1.784 1.374～2.361 0.034
淋巴结平均直径(<1 cm，≥1 cm) 1.889 1.259～2.628 0.036
医师经验(丰富，不丰富) 2.017 1.397～3.016 0.045
[1]
Bohec H, Breuskin I，Hadoux J，et al.Occult contralateral lateral lymph node metastases in unilateral N1b papillary thyroid carcinoma[J]. World J Surg, 2018, 43(3):818-823.
[2]
杜峻峰，安然，李世拥．分化型甲状腺癌术中纳米碳示踪对颈淋巴结清扫的指导意义[J/CD]. 中华普外科手术学杂志(电子版), 2018, 12(6):462-465.
[3]
Maksimovic S，Jakovljevic B，Gojkovic Z. Lymph node metastases papillary thyroid carcinoma and their importance in recurrence of disease[J]. Med Arch, 2018, 72(2):108-111.
[4]
赵淑艳，马云海，尹哲，等. cN0T1/T2期甲状腺乳头状癌中央区淋巴结清扫观点的变迁及反思[J]. 中国普外基础与临床杂志，2018, 25(7):863-866.
[5]
Mandapathil M，Lennon P，Ganly I，et al.Significance and management of incidentally diagnosed metastatic papillary thyroid carcinoma in cervical lymph nodes in neck dissection specimens[J]. Head Neck, 2019，41(11):3783-3787.
[6]
郗洪庆，菅雁兵，陈志达，等．吲哚菁绿荧光实时成像技术在甲状腺癌根治术淋巴结清扫中的初步应用研究[J]．中华内分泌外科杂志，2019, 13(3):219-223.
[7]
Zhao WJ，Luo H，Zhou YM，et al.Preoperative ultrasound-guided carbon nanoparticles localization for metastatic lymph nodes in papillary thyroid carcinoma during reoperation: A retrospective cohort study[J]. Medicine(Baltimore), 2017, 96(10):e6285.
[8]
中国抗癌协会甲状腺癌专业委员会(CATO). 甲状腺微小乳头状癌诊断与治疗中国专家共识(2016版)[J]. 中国肿瘤临床，2016, 43(10):405-411.
[9]
Yordanova A, Mahjoob S，Lingohr P，et al.Diagnostic accuracy of [99mTc]Tc-Sestamibi in the assessment of thyroid nodules[J]. Oncotarget, 2017, 8(55):94681-94691.
[10]
Sojak J，Si？ák M，Kali? A，et al.Papillary thyroid carcinoma: analysis of the central compartment's lymph nodes metastases[J]. Acta Medica(Hradec Kralove), 2017, 60(1):44-50.
[11]
Arora S，Prabhu M，Damle NA，et al.Prostate-specific Membrane Antigen Imaging in Recurrent Medullary Thyroid Cancer: A New Theranostic Tracer in the Offing [J]. Indian J Nucl Med, 2018, 33(3):261-263.
[12]
赵淑艳，马云海，尹哲，等. cN0 T1/T2期甲状腺乳头状癌行颈中央区淋巴清扫的合理性及其范围的探讨[J]．中华耳鼻咽喉头颈外科杂志，2018，53(2):105-109.
[13]
Samnick S，Al-Momani E，Schmid JS，et al.Initial clinical investigation of [18F]tetrafluoroborate PET/CT in comparison to [124]iodine PET/CT for imaging thyroid cancer[J]. Clin Nucl Med, 2018, 43(3):162-167.
[14]
Min L，Lang BHH，Chen W，et al. Utility of activated carbon nanoparticle (CNP) during total thyroidectomy for clinically nodal positive papillary thyroid carcinoma (PTC)[J]. World J Surg, 2020，44(2):356-362.
[15]
Goran M, Pekmezovic T, Markovic I，et al.Lymph node metastases in clinically N0 patients with papillary thyroid microcarcinomas-A single institution experience[J]．J BUON，2017，22(1):224-231.
[16]
Eweida AM, Sakr MF, Hamza Y, et al. Level I lymph node involvement in patients with N1b papillary thyroid carcinoma: a prospective study[J]. Eur Arch Otorhinolaryngol，2017, 274(4):1951-1958.
[17]
Spanu A，Nuvoli S，Gelo I，et al.The role of diagnostic 131 I-SPECT/TC in patients with papillary thyroid microcarcinoma in long-term follow-up[J]. J Nucl Med, 2018, 59(10):1510-1515.
[18]
Liu L，Zhu J，Lu CJ，et al. Application value of nanocarbon lymphatic tracer in thoraco-laparoscopic esophagectomy[J]. Minerva Chir, 2017, 72(6):475-482.
[19]
Do SI，Kim HS，Kim K，et al.Predictive Value of Sphingosine Kinase 1 Expression in Papillary Thyroid Carcinoma[J]. Anticancer Res, 2017, 37(10):5399-5405.
[20]
王新征，刘金彪，侯永强，等．影响纳米炭在乳腺癌前哨淋巴结中活检成功率因素的logistic回归分析[J]．中南大学学报(医学版)，2016，41(4):411-416.
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