Wang Yonghui, Zhang Li, Huang Jinning, Wang Liquan
Department of Thyroid and Breast Surgery, Weifang People's Hospital, Weifang, China.
Front Oncol. 2023 Mar 9;13:1120411. doi: 10.3389/fonc.2023.1120411. eCollection 2023.
Carbon nanoparticles (CNs) have been widely used in the protection of the parathyroid gland and act as a tracer agent in central lymph node dissection. However, the right time for CN injection has not been well illustrated in the transoral endoscopic thyroidectomy vestibular approach (TOETVA). The purpose of this study was to evaluate the safety and feasibility of the preoperative injection of CNs in TOETVA for papillary thyroid cancer.
From October 2021 to October 2022, a total of 53 consecutive patients with PTC were retrospectively analyzed. All patients underwent unilateral thyroidectomy the TOETVA. The patients were divided into the preoperative group ( = 28) and the intraoperative group ( = 25) according to CN injection time. In the preoperative group, 0.2 ml of CNs were injected into the thyroid lobules with malignant nodules 1 h before surgery. The numbers of total central lymph node (CLN) and metastatic central lymph node (CLNM), parathyroid autotransplantation, accidental removal of the parathyroid, and the parathyroid hormone level were recorded and analyzed.
The leakage of CNs happened more frequently in the intraoperative group than in the preoperative group ( = 0.002). The mean number of retrieved CLN and CLNM was similar in the preoperative group and the intraoperative group. In parathyroid protection, more parathyroid was discovered in the preoperative group than in the intraoperative group (1.57 ± 0.54 . 1.47 ± 0.50, = 0.002), but less parathyroid autotransplantation ( = 0.004) and accidental removal of the parathyroid ( = 0.036) were discovered in the preoperative group. However, the PTH level between the two groups was similar after the first day and the first month.
The preoperative injection of CNs is a safe and effective method to protect the parathyroid glands (PGs) in patients with PTC undergoing TOETVA. However, the value of preoperative injection of CNs in TOETVA for central lymph node dissection needs to be further studied.
碳纳米颗粒（CNs）已广泛应用于甲状旁腺保护，并作为中央淋巴结清扫术中的示踪剂。然而，在经口内镜甲状腺手术前庭入路（TOETVA）中，CNs注射的最佳时机尚未得到充分阐明。本研究的目的是评估术前注射CNs在TOETVA治疗甲状腺乳头状癌中的安全性和可行性。
回顾性分析2021年10月至2022年10月期间连续收治的53例PTC患者。所有患者均采用TOETVA行单侧甲状腺切除术。根据CNs注射时间将患者分为术前组（n = 28）和术中组（n = 25）。术前组在手术前1小时将0.2 ml CNs注入有恶性结节的甲状腺小叶。记录并分析中央淋巴结（CLN）总数、转移中央淋巴结（CLNM）数、甲状旁腺自体移植情况、甲状旁腺意外切除情况及甲状旁腺激素水平。
术中组CNs渗漏的发生率高于术前组（P = 0.002）。术前组和术中组回收的CLN和CLNM平均数相似。在甲状旁腺保护方面，术前组发现的甲状旁腺比术中组多（1.57±0.54 vs. 1.47±0.50，P = 0.002），但术前组甲状旁腺自体移植（P = 0.004）和甲状旁腺意外切除（P = 0.036）的发生率较低。然而，两组术后第1天和第1个月的PTH水平相似。
术前注射CNs是TOETVA治疗PTC患者时保护甲状旁腺的一种安全有效的方法。然而，术前注射CNs在TOETVA中央淋巴结清扫中的价值仍需进一步研究。
