纳米碳混悬液示踪前哨淋巴结在cNO分化型甲状腺癌术中的应用研究

发布时间：2018-06-15 08:36

本文选题：纳米碳 + 甲状腺癌　；参考：《大连医科大学》2017年硕士论文

【摘要】：目的:探讨纳米碳混悬液示踪前哨淋巴结活检在cNO分化型甲状腺癌术中的应用价值,评价其临床疗效及应用效果,以指导临床工作。方法:选取大连大学附属中山医院乳腺甲状腺科2013年1月～2014年10月行手术治疗的cNO分化型甲状腺癌患者96例作为研究对象,患者均经术前细针抽吸活检或术中冰冻诊断为分化型甲状腺癌,术前颈部CT增强检查与彩超检查均未见颈部淋巴结转移,均为首次接受手术治疗患者,且无甲状腺切除术的禁忌症。对上述患者的临床资料进行回顾性分析,其中术中使用纳米碳混悬液病例设为淋巴结示踪组(示踪组),同期术中未使用纳米碳混悬液病例设为空白对照组(对照组),各48例。比较淋巴结清扫数目、手术相关指标(手术时间、术中出血量、术后引流量)、甲状旁腺功能、术后24个月回访颈部淋巴结转移情况。结果:示踪组手术时间为(80.7±11.4)min、术中出血量为(41.3±8.4)ml、术后引流量为(72.4± 12.3)ml;对照组手术时间为(84.6± 12.4)min、术中出血量为(43.7±9.1)ml、术后引流量为(74.5±13.9)mml。两组上述各指标比较均无统计学意义(P0.05);示踪组术后低钙血症发生率为4.2%(2/48),对照组为20.8%(10/48),组间比较有统计学差异(P0.05);示踪组术后1d甲状旁腺激素(PTH)水平为(35.36± 18.35)ng/L,对照组为(26.58±15.80)ng/L,比较有统计学差异(P0.05);淋巴结示踪组术后1周PTH水平为(37.67 ±17.29)ng/L,对照组为(28.06±17.15)ng/L,组间比较有统计学差异(P0.01)。示踪组行中央区淋巴结清扫例数15例,对照组全部行预防性中央组淋巴结清扫。示踪组行中央区淋巴结清扫者切除淋巴结的数目为(9.40±2.35)枚,对照组为(7.86±2.06)枚,组间比较有统计学差异(P0.01)。术后门诊随访24个月显示两组术后72h发生甲状旁腺功能低下或低钙血症者其血PTH、Ca+水平均恢复至正常范围,示踪组和对照组的局部复发率和远处转移发生率比较差异均无统计学意义(P0.05),两组均未出现永久性甲状旁腺功能低下和喉返神经损伤病例。结论:前哨淋巴结活检可发现早期转移的颈部淋巴结,对是否行中央区淋巴结清扫具有指导意义;手术时间、术后引流量及术后并发症并没因纳米碳混悬液的使用而增加,相反,淋巴结清扫率的提高,降低了病人二次手术的风险,同时有助于识别甲状旁腺并保护甲状旁腺功能,具有重要临床应用价值。
[Abstract]:Objective: to evaluate the value of sentinel lymph node biopsy with nano-carbon suspension in the operation of CNO differentiated thyroid carcinoma. Methods: Ninety-six patients with CNO differentiated thyroid carcinoma were selected from Department of Breast thyroid of Zhongshan Hospital affiliated to Dalian University from January 2013 to October 2014. All the patients were diagnosed as differentiated thyroid carcinoma by preoperative fine needle aspiration biopsy or intraoperative freezing. There was no cervical lymph node metastasis on CT enhanced scan and color Doppler ultrasonography before operation. All patients were treated with surgery for the first time. There was no contraindication for thyroidectomy. The clinical data of the above patients were retrospectively analyzed. The cases with nano-carbon suspension were divided into lymph node tracer group (tracer group) and blank control group (control group, 48 cases, respectively). The number of lymph nodes dissection, operative parameters (operation time, intraoperative blood loss, postoperative drainage, parathyroid function, and neck lymph node metastasis 24 months after operation) were compared. Results: in the tracer group, the operative time was 80.7 卤11.4 min, the intraoperative bleeding volume was 41.3 卤8.4 ml, the postoperative drainage volume was 72.4 卤12.3 ml, in the control group the operative time was 84.6 卤12.4 min, the intraoperative bleeding volume was 43.7 卤9.1 ml, and the postoperative drainage volume was 74.5 卤13.9mml. In the tracer group, the incidence of hypocalcemia was 4.22 / 48, the control group was 20.8 / 10 / 48, the level of PTH in the tracer group was 35.36 卤18.35 ng / L, and in the control group was 26.58 卤15.80 ng / L, the level of PTH in the tracer group was 35.36 卤18.35 ng / L on the 1st day after operation, and that in the control group was 26.58 卤15.80 ng / L, respectively. The level of PTH was 37.67 卤17.29 ng / L in the lymph node tracer group and 28.06 卤17.15 ng / L in the control group (P < 0.01). There were 15 cases of central lymph node dissection in tracer group and 15 cases in control group. The number of dissected lymph nodes was 9.40 卤2.35 in the tracer group and 7.86 卤2.06 in the control group. There was significant difference between the two groups (P 0.01). Follow-up 24 months after operation showed that the serum PTH Ca levels of patients with hypoparathyroidism or hypocalcemia in both groups recovered to normal range 72 hours after operation. There was no significant difference in local recurrence rate and distant metastasis rate between tracer group and control group (P 0.05). There were no cases of permanent hypoparathyroidism and recurrent laryngeal nerve injury in both groups. Conclusion: sentinel lymph node biopsy can find the cervical lymph nodes with early metastasis, which is helpful to the central lymph node dissection, and the operative time, postoperative drainage and postoperative complications are not increased by the use of nano-carbon suspension. On the contrary, the increase of lymph node dissection rate reduces the risk of secondary operation, and helps to identify parathyroid gland and protect parathyroid function, which has important clinical application value.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R736.1

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