纳米碳在分化型甲状腺癌再次手术中应用价值的探讨
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摘要
目的探讨纳米碳在分化型甲状腺癌(differentiated thyroid carcinoma,DTC)再次手术中的应用价值。方法回顾性分析2012-07~2016-07该科收治的95例DTC患者再次手术临床资料,其中注射纳米碳50例为纳米碳组,未注射的45例为对照组。比较两组淋巴结清扫、转移枚数和术中识别、误切甲状旁腺枚数的差异,以及手术时间、术后甲状旁腺功能、喉上喉返神经损伤并发症的差异。结果纳米碳组淋巴结清扫枚数、转移淋巴结枚数多于对照组(P<0.05),术中识别甲状旁腺枚数多于对照组(P<0.05),而误切例数少于对照组(P<0.05)。纳米碳组手术时间短于对照组(P<0.05),且一过性的甲状旁腺功能减退及神经损伤发生率低于对照组(P<0.05)。结论在DTC再次手术中使用纳米碳能提高淋巴结清扫的彻底性,起到了识别和保护甲状旁腺及神经的作用,减少术后并发症却未增加手术时间。
Objective To investigate the application of carbon nanoparticles in reoperation of differentiated thyroid carcinoma( DTC) surgery. Methods The clinical data of 95 patients who were performed reoperation of DTC in our department from July 2012 to July 2016 were retrospectively analyzed. The patients were divided into the carbon nanoparticles group( n = 50) and the control group( n = 45). The number of lymph nodes of dissection and metastasis,the cases of identify and mistaken cutting parathyroid glands,the operation time,parathyroid function,superior laryngeal nerve and recurrent laryngeal nerve injury were compared between the two groups. Results The number of lymph nodes of dissection and metastases in the carbon nanoparticles group was more than that in the control group( P < 0. 05). The number of parathyroid identified during the operation was more and the number of cutting parathyroid glands by mistake was less in the carbon nanoparticles group than those in the control group( P < 0. 05). The operation time and postoperative complications,the incidence of transient hypoparathyroidism,superior laryngeal nerve and recurrent laryngeal nerve injury in the carbon nanoparticles group were less than those in the control group( P < 0. 05). Conclusion Application of carbon nanopartieles can improve the detection rate of lymph nodes and the rate of thorough dissection,protect the parathyroid glands and nerves and reduce the operation time in the reoperation of DTC.
Objective To investigate the application of carbon nanoparticles in reoperation of differentiated thyroid carcinoma( DTC) surgery. Methods The clinical data of 95 patients who were performed reoperation of DTC in our department from July 2012 to July 2016 were retrospectively analyzed. The patients were divided into the carbon nanoparticles group( n = 50) and the control group( n = 45). The number of lymph nodes of dissection and metastasis,the cases of identify and mistaken cutting parathyroid glands,the operation time,parathyroid function,superior laryngeal nerve and recurrent laryngeal nerve injury were compared between the two groups. Results The number of lymph nodes of dissection and metastases in the carbon nanoparticles group was more than that in the control group( P < 0. 05). The number of parathyroid identified during the operation was more and the number of cutting parathyroid glands by mistake was less in the carbon nanoparticles group than those in the control group( P < 0. 05). The operation time and postoperative complications,the incidence of transient hypoparathyroidism,superior laryngeal nerve and recurrent laryngeal nerve injury in the carbon nanoparticles group were less than those in the control group( P < 0. 05). Conclusion Application of carbon nanopartieles can improve the detection rate of lymph nodes and the rate of thorough dissection,protect the parathyroid glands and nerves and reduce the operation time in the reoperation of DTC.
引文
1张传平,方文成.甲状腺再次手术胸锁乳突肌内侧缘入路与颈白线入路的临床探讨[J].中国现代普通外科进展,2015,18(9):681-683,691.
2 Giordano D,Valcavi R,Thompson GB,et al.Complications of central neck dissection in patients with papillary thyroid carcinoma:results of a study on 1087 patients and review of the literature[J].Thyroid,2012,22(9):911-917.
3 Cavalheiro BG,Matos LL,Leite AK,et al.Surgical treatment for thyroid carcinoma:retrospective study with 811 patients in a Brazilian tertiary hospital[J].Arch Endocrinol Metab,2016,60(5):472-478.
4 高文超,石臣磊,石铁锋,等.甲状腺全切除术中纳米碳混悬注射液对提高甲状旁腺识别及旁腺功能保护作用的研究[J].中华普通外科杂志,2016,31(12):1001-1004.
5 Varaldo E,Ansaldo GL,Mascherini M,et al.Neurological complications in thyroid surgery:a surgical point of view on laryngeal nerves[J].Front Endocrinol(Lausanne),2014,15(5):108.
6 张润,王思洋,汪晓东,等.纳米碳的临床应用研究进展[J].肿瘤学杂志,2012,18(11):865-869.
7 Liu R,Gilmore DM,Zubris KAV,et al.Prevention of nodal metastases in breast cancer following the lymphatic migration of paclitaxelloaded expansile nanoparticles[J].Biomaterials,2013,34(7):1810-1819.
8 Wang Y,Deng H,Chen H,et al.Preoperative submucosal injection of carbon nanoparticles improves lymph node staging accuracy in rectal cancer after neoadjuvant chemoradiotherapy[J].J Am Coll Surg,2015,221(5):923-930.
9 Muthukumar T,Chamundeeswari M,Prabhavathi S,et al.Carbon nanoparticle from a natural source fabricated for folatereceptor targeting,imaging and drug delivery application in A549 lung cancer cells[J].Eur J Pharm Biopharm,2014,88(3):730-736.
10 Hao RT,Chen J,Zhao LH,et al.Sentinel lymph node biopsy using carbon nanoparticles for Chinese patients with papillary thyroid microcarcinoma[J].Eur J Surg Oncol,2012,38(8):718-724.
11 Wang L,Yang D,Lv JY,et al.Application of carbon nanoparticles in lymph node dissection and parathyroid protection during thyroid cancer surgeries:a systematic review and meta-analysis[J].Onco Targets Ther,2017,10(2):1247-1260.
12 Yu W,Cao X,Xu G,et al.Potential role for carbon nanoparticles to guide central neck dissection in patients with papillary thyroid cancer[J].Surgery,2016,160(3):755-761.
13 Tian W,Jiang Y,Gao B,et al.Application of nano-carbon in lymph node dissection for thyroid cancer and protection of parathyroid glands[J].Med Sci Monit,2014,20:1925-1930.
14 Docimo G,Tolone S,Ruggiero R,et al.Total thyroidectomy without prophylactic central neck dissection combined with routine oral calciumand vitamin D supplements:is it a good option to achieve a low recurrence rate avoiding hypocalcemia?A retrospective study[J].Minerva Chir,2013,68(3):321-328.
15 赵婉君,罗晗,苟泽辉,等.甲状腺癌再次手术时纳米碳引导下的精准淋巴结清扫[J].中国普外基础与临床杂志,2016,23(10):1220-1224.
16 Gu J,Wang J,Nie X,et al.Potential role for carbon nanoparticles identification and preservation in situ of parathyroid glands during total thyroidectomy and central compartment node dissection[J].Int J Clin Exp Med,2015,8(6):9640-9648.
2 Giordano D,Valcavi R,Thompson GB,et al.Complications of central neck dissection in patients with papillary thyroid carcinoma:results of a study on 1087 patients and review of the literature[J].Thyroid,2012,22(9):911-917.
3 Cavalheiro BG,Matos LL,Leite AK,et al.Surgical treatment for thyroid carcinoma:retrospective study with 811 patients in a Brazilian tertiary hospital[J].Arch Endocrinol Metab,2016,60(5):472-478.
4 高文超,石臣磊,石铁锋,等.甲状腺全切除术中纳米碳混悬注射液对提高甲状旁腺识别及旁腺功能保护作用的研究[J].中华普通外科杂志,2016,31(12):1001-1004.
5 Varaldo E,Ansaldo GL,Mascherini M,et al.Neurological complications in thyroid surgery:a surgical point of view on laryngeal nerves[J].Front Endocrinol(Lausanne),2014,15(5):108.
6 张润,王思洋,汪晓东,等.纳米碳的临床应用研究进展[J].肿瘤学杂志,2012,18(11):865-869.
7 Liu R,Gilmore DM,Zubris KAV,et al.Prevention of nodal metastases in breast cancer following the lymphatic migration of paclitaxelloaded expansile nanoparticles[J].Biomaterials,2013,34(7):1810-1819.
8 Wang Y,Deng H,Chen H,et al.Preoperative submucosal injection of carbon nanoparticles improves lymph node staging accuracy in rectal cancer after neoadjuvant chemoradiotherapy[J].J Am Coll Surg,2015,221(5):923-930.
9 Muthukumar T,Chamundeeswari M,Prabhavathi S,et al.Carbon nanoparticle from a natural source fabricated for folatereceptor targeting,imaging and drug delivery application in A549 lung cancer cells[J].Eur J Pharm Biopharm,2014,88(3):730-736.
10 Hao RT,Chen J,Zhao LH,et al.Sentinel lymph node biopsy using carbon nanoparticles for Chinese patients with papillary thyroid microcarcinoma[J].Eur J Surg Oncol,2012,38(8):718-724.
11 Wang L,Yang D,Lv JY,et al.Application of carbon nanoparticles in lymph node dissection and parathyroid protection during thyroid cancer surgeries:a systematic review and meta-analysis[J].Onco Targets Ther,2017,10(2):1247-1260.
12 Yu W,Cao X,Xu G,et al.Potential role for carbon nanoparticles to guide central neck dissection in patients with papillary thyroid cancer[J].Surgery,2016,160(3):755-761.
13 Tian W,Jiang Y,Gao B,et al.Application of nano-carbon in lymph node dissection for thyroid cancer and protection of parathyroid glands[J].Med Sci Monit,2014,20:1925-1930.
14 Docimo G,Tolone S,Ruggiero R,et al.Total thyroidectomy without prophylactic central neck dissection combined with routine oral calciumand vitamin D supplements:is it a good option to achieve a low recurrence rate avoiding hypocalcemia?A retrospective study[J].Minerva Chir,2013,68(3):321-328.
15 赵婉君,罗晗,苟泽辉,等.甲状腺癌再次手术时纳米碳引导下的精准淋巴结清扫[J].中国普外基础与临床杂志,2016,23(10):1220-1224.
16 Gu J,Wang J,Nie X,et al.Potential role for carbon nanoparticles identification and preservation in situ of parathyroid glands during total thyroidectomy and central compartment node dissection[J].Int J Clin Exp Med,2015,8(6):9640-9648.