Department of Head and Neck Surgery, Cancer Hospital, Shantou University Medical College, Shantou, China.
Department of Oncology, Cancer Hospital, Shantou University Medical College, Shantou, China.
PLoS One. 2020 Nov 10;15(11):e0223627. doi: 10.1371/journal.pone.0223627. eCollection 2020.
To assess the efficiency of the carbon nanoparticles (CNs) in lymph node identification and parathyroid gland (PG) protection during thyroidectomy for non-anaplastic thyroid carcinoma (N-ATC).
A systematic literature search for relevant literatures published up to December 2018 in PubMed, EMBASE, Web of Science and Cochrane Library was performed. Both English and Chinese literatures were retrieved and analyzed. Randomized controlled trials or nonrandomized controlled trials comparing the use of CNs with the use of methylene blue or a blank control in patients undergoing thyroidectomy for N-ATC were enrolled in this study. The primary outcomes included the number of lymph nodes harvested, the rate of lymph nodes involved, and the rates of accidental parathyroidectomy, hypoparathyroidism, and hypocalcemia. Weighted mean differences (WMDs), odds ratios (ORs) and risk differences (RDs) were calculated for the dichotomous outcome variables. Between study heterogeneity was tested using the Q tests and the I2 statistics. All analyses were performed using Review Manager (version 5.3.5).
25 studies comprising 3266 patients were included in this analysis. The total number of lymph nodes harvested in the CNs groups was significantly higher than that in the control groups (WMD, 2.36; 95% CI, 1.40 to 3.32; P <0.01). Administrating CNs was associated with a lower incidence of accidental PG removal (OR = 0.28, 95% CI = 0.21 to 0.37, P<0.01) and lower rates of both postoperative transient hypoparathyroidism (OR = 0.46, 95% CI = 0.33 to 0.64, P <0.01) and transient hypocalcemia (OR = 0.46, 95% CI = 0.33 to 0.65, P <0.01). No significant difference was found concerning lymph node metastatic rates between CNs group and control group. Subgroup analysis indicated that the application of CNs in reoperation thyroidectomy reduced both the rate of transient hypoparathyroidism (OR = 0.21, 95% CI = 0.06 to 0.75, P = 0.02) and the possibility of accidental PGs removal (OR = 0.21, 95% CI = 0.07 to 0.62, P = 0.004, P<0.05).
The application of CNs in thyroidectomy for N-ATC results in higher number of lymph node harvested and better PG protection during both initial and reoperation thyroidectomy.
评估碳纳米粒子（CNs）在非典型甲状腺癌（N-ATC）甲状腺切除术期间用于淋巴结识别和甲状旁腺（PG）保护的效率。
系统检索 PubMed、EMBASE、Web of Science 和 Cochrane Library 截至 2018 年 12 月发表的相关文献，并检索和分析中英文文献。本研究纳入了比较 CNs 与亚甲蓝或空白对照在 N-ATC 甲状腺切除术患者中使用的随机对照试验或非随机对照试验。主要结局包括采集的淋巴结数量、淋巴结受累率以及意外甲状旁腺切除术、甲状旁腺功能减退症和低钙血症的发生率。对二分类结局变量使用加权均数差（WMD）、比值比（OR）和风险差异（RD）进行计算。使用 Q 检验和 I2 统计量测试研究间异质性。所有分析均使用 Review Manager（版本 5.3.5）进行。
共有 25 项研究纳入 3266 例患者进行分析。CNs 组采集的淋巴结总数明显高于对照组（WMD，2.36；95%CI，1.40 至 3.32；P<0.01）。给予 CNs 与意外 PG 切除发生率降低相关（OR=0.28，95%CI=0.21 至 0.37，P<0.01），且术后短暂性甲状旁腺功能减退症（OR=0.46，95%CI=0.33 至 0.64，P<0.01）和短暂性低钙血症（OR=0.46，95%CI=0.33 至 0.65，P<0.01）的发生率也降低。CNs 组与对照组的淋巴结转移率无显著差异。亚组分析表明，CNs 在再次手术甲状腺切除术中的应用降低了短暂性甲状旁腺功能减退症的发生率（OR=0.21，95%CI=0.06 至 0.75，P=0.02）和意外 PG 切除的可能性（OR=0.21，95%CI=0.07 至 0.62，P=0.004，P<0.05）。
CNs 在 N-ATC 甲状腺切除术的应用可增加淋巴结采集数量，并在初次和再次手术甲状腺切除术中更好地保护 PG。
