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一种碳纳米颗粒淋巴示踪剂在甲状腺乳头状非微小癌根治性甲状腺切除术中保护甲状旁腺。

A Carbon Nanoparticle Lymphatic Tracer Protected Parathyroid Glands During Radical Thyroidectomy for Papillary Thyroid Non-Microcarcinoma.

作者信息

Long Miaoyun, Luo Dingyuan, Diao Feiyu, Huang Mingqing, Huang Kai, Peng Xinzhi, Lin Shaojian, Li Honghao

机构信息

1 Sun Yat-sen Memorial Hospital, Guangzhou, China.

出版信息

Surg Innov. 2017 Feb;24(1):29-34. doi: 10.1177/1553350616668088. Epub 2016 Sep 23.

Abstract

The study assessed the role of an activated carbon nanoparticle lymphatic tracer in reducing unintentional damage to the parathyroid glands during thyroidectomy for papillary thyroid non-microcarcinoma diagnosed intraoperatively by cryosections. A total of 103 patients with papillary thyroid non-microcarcinomas diagnosed by intraoperative cryosection were randomly assigned to receive routine radical thyroidectomy or radical thyroidectomy following administration of activated carbon nanoparticle lymphatic tracer to the contralateral thyroid, at the department of Thyroid Surgery, Sun Yat-sen Memorial Hospital (Guangzhou, China), between January 2012 and May 2013. The success of level VI lymphadenectomy and postoperative parathyroid function were compared. Administration of the activated carbon nanoparticle lymphatic tracer did not affect the frequency of recovered lymph nodes containing metastases; however, it did significantly reduce the incidence of permanent and transient hypoparathyroidism from 2 to 0 and 18 to 6, and reduced the mean recovery time for transient hypoparathyroidism from 57.0 days to 22.3 days. Administration of activated carbon nanoparticles to the contralateral thyroid after intraoperative cryosections did not contribute to lymphadenectomy for papillary thyroid non-microcarcinoma, but significantly protected parathyroid functions. This approach could decrease the morbidity of radical thyroidectomy and the occurrence of hypoparathyroidism.

摘要

本研究评估了活性炭纳米颗粒淋巴管示踪剂在减少术中经冷冻切片诊断为甲状腺乳头状非微小癌的甲状腺切除术中对甲状旁腺无意损伤方面的作用。2012年1月至2013年5月期间,在中国广州中山大学附属孙逸仙纪念医院甲状腺外科,共有103例经术中冷冻切片诊断为甲状腺乳头状非微小癌的患者被随机分配接受常规根治性甲状腺切除术或在对侧甲状腺给予活性炭纳米颗粒淋巴管示踪剂后进行根治性甲状腺切除术。比较了Ⅵ区淋巴结清扫的成功率和术后甲状旁腺功能。活性炭纳米颗粒淋巴管示踪剂的应用并未影响含有转移灶的回收淋巴结的频率;然而,它确实显著降低了永久性和暂时性甲状旁腺功能减退的发生率,从2例降至0例,从18例降至6例,并将暂时性甲状旁腺功能减退的平均恢复时间从57.0天缩短至22.3天。术中冷冻切片后对对侧甲状腺给予活性炭纳米颗粒对甲状腺乳头状非微小癌的淋巴结清扫没有帮助,但显著保护了甲状旁腺功能。这种方法可以降低根治性甲状腺切除术的发病率和甲状旁腺功能减退的发生率。

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