Wu Ganxun, Cai Li, Hu Junlan, Zhao Ruili, Ge Junheng, Zhao Yan, Shi Jian, Wang Zhanlong
Department of Otolaryngology Head & Neck Surgery, Fourth Hospital of Hebei Medical University, Tumor Hospital of Hebei, Shijiazhuang 050011, China.
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Zhonghua Yi Xue Za Zhi. 2015 Mar 31;95(12):912-6.
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.
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.
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 (χ(2) = 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).
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.
评估碳纳米颗粒在甲状腺癌患者行全甲状腺切除加双侧中央区颈淋巴结清扫术中对解剖淋巴结及保护甲状旁腺的作用。
86例拟行全甲状腺切除加双侧中央区颈淋巴结清扫术的甲状腺癌患者随机分为试验组和对照组。试验组将碳纳米颗粒注入甲状腺。在中央区清扫标本中计数试验组的总淋巴结、转移淋巴结、黑色染色淋巴结及黑色染色转移淋巴结。对照组在中央区清扫标本中计数总淋巴结及转移淋巴结。两组均在中央区清扫标本中计数甲状旁腺。两组于术前及术后1天、3天、5天、1个月、3个月和6个月测定血清总钙及甲状旁腺激素。
试验组平均淋巴结计数（10.19±4.27）个及黑色染色淋巴结计数（8.44±4.31）个均多于对照组的（6.26±2.98）个淋巴结（均P<0.01）。试验组发现甲状旁腺7个，对照组发现11个。差异无统计学意义（χ(2)=1.124，P=0.289）。两组术前血清钙及甲状旁腺激素水平在术后6个月内均下降（均P<0.01）。无包膜外侵犯时，试验组术后5天、1个月和3个月血清钙及甲状旁腺激素水平高于对照组（均P<0.05）。发生淋巴结转移时，试验组术后1个月血清钙（t=3.446，P=0.001）及甲状旁腺激素（t=2.441，P=0.017）水平高于对照组。有包膜外侵犯或无淋巴结转移时，术后6个月内血清钙及甲状旁腺激素水平组间无统计学差异（均P>0.05）。肿瘤大小≤4 cm时，试验组术后1个月甲状旁腺激素水平高于对照组（t=2.703，P=0.009）。但肿瘤大小>4 cm时，术后6个月内组间无统计学差异（均P>0.05）。无论肿瘤大小，试验组术后1个月血清钙水平均高于对照组（均P<0.01）。
对于甲状腺癌患者，全甲状腺切除加双侧中央区颈淋巴结清扫术增加了甲状旁腺功能减退的发生率。碳纳米颗粒可标记中央区淋巴结，提高淋巴结检出率。在发生淋巴结转移或无包膜外侵犯时，碳纳米颗粒可充分保护甲状旁腺功能。
