术前注射碳纳米颗粒对甲状腺乳头状癌患者有益：一项针对102例患者的前瞻性研究
Preoperative injection of carbon nanoparticles is beneficial to the patients with thyroid papillary carcinoma: From a prospective study of 102 cases.
作者信息
Yan Shouyi, Zhao Wenxin, Wang Bo, Zhang Liyong
机构信息
Department of Thyroid and Vascular Surgery Department of General Surgery Minimal Invasive Center, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.
出版信息
Medicine (Baltimore). 2018 Jul;97(27):e11364. doi: 10.1097/MD.0000000000011364.
BACKGROUND
More surgeons had noticed the importance of carbon nanoparticles (CNs) in protection of parathyroid grand in the surgery of thyroidectomy and central lymph lode dissection, but paid less attention to the injection time. The purpose of this study was to investigate whether preoperative injection of CNs can improve the dissection of lymph nodes (LNs) and protect parathyroid grand (PG) for the patients with papillary thyroid carcinoma (TC).
METHODS
A total of 102 consecutive patients were enrolled into this study from August 2016 to June 2017. All the patients were divided randomly into preoperative group and intraoperative group by the injecting time of the CNs. We compared the patients who had CNs injected into thyroid gland 1 month before surgery with a control group of patients who had CNs injected during the operation. The primary endpoints were operative time, numbers of total LN and metastatic LN, ratio of PG auto-transplantation, parathyroid hormone (PTH) level, and postoperative complications.
RESULTS
We identify 206 PGs and 162 PGs in the preoperative and intraoperative group, respectively, (P = .000) and there was low ratio of auto-transplantation in the preoperative group compared with the intraoperative group (39.3% vs 50.62%, P = .003). We also found that the PTH level in the preoperative group was higher than that of preoperative group (2.60 ± 1.00 vs 2.19 ± 0.72, P = .021), and the operation time in the preoperative group was less than the intraoperative group (60.17 ± 6.28 vs 80.94 ± 7.12, P = .000). Meanwhile pathological results revealed 3 PGs of accidental removal occurred in the preoperative group, whereas 9 PGs of accidental removal occurred in the intraoperative group (P = .039). Also there was no difference in the numbers of total and metastatic LN in the 2 groups (P > .05).
CONCLUSION
Preoperative injection of CNs was safe, and can help protect PG and reduce the difficulty of operation.
背景
越来越多的外科医生已经注意到碳纳米颗粒（CNs）在甲状腺切除术和中央淋巴结清扫术中保护甲状旁腺方面的重要性，但对其注射时间关注较少。本研究的目的是探讨术前注射CNs是否能改善乳头状甲状腺癌（TC）患者的淋巴结（LNs）清扫并保护甲状旁腺（PG）。
方法
2016年8月至2017年6月，共有102例连续患者纳入本研究。根据CNs的注射时间，将所有患者随机分为术前组和术中组。我们将术前1个月将CNs注入甲状腺的患者与术中注入CNs的对照组患者进行比较。主要终点指标包括手术时间、总淋巴结和转移淋巴结数量、PG自体移植率、甲状旁腺激素（PTH）水平及术后并发症。
结果
术前组和术中组分别识别出206个和162个PG（P = 0.000），与术中组相比，术前组的自体移植率较低（39.3%对50.62%，P = 0.003）。我们还发现术前组的PTH水平高于术中组（2.60±1.00对2.19±0.72，P = 0.021），术前组的手术时间短于术中组（60.17±6.28对80.94±7.12，P = 0.000）。同时，病理结果显示术前组有3个PG意外切除，而术中组有9个PG意外切除（P = 0.039）。两组的总淋巴结和转移淋巴结数量也无差异（P>0.05）。
结论
术前注射CNs是安全的，有助于保护PG并降低手术难度。
Zotero 插件