Preoperative ultrasound-guided carbon nanoparticles localization for metastatic lymph nodes in papillary thyroid carcinoma during reoperation: A retrospective cohort study.
Preoperative ultrasound-guided carbon nanoparticles localization for metastatic lymph nodes in papillary thyroid carcinoma during reoperation: A retrospective cohort study.
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DOI：
10.1097/md.0000000000006285
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发表时间：
2017-03
期刊：
影响因子：
1.6
通讯作者：
Zhu JQ
中科院分区：
文献类型：
--
作者：
Zhao WJ;Luo H;Zhou YM;Gou ZH;Wang B;Zhu JQ
由于甲状腺乳头状癌解剖结构受损，术野存在大量纤维组织和疤痕组织，再次手术难度较大。本研究介绍了一种在再手术期间定位转移淋巴结的新方法，并评估了术前超声引导碳纳米颗粒（CNs）定位的有效性和安全性。本回顾性队列研究纳入2015年10月至2016年2月经组织病理学诊断为淋巴结转移并接受再次手术的52例患者，行改良根治性颈清扫术或选择性颈淋巴结清扫术。共有26名患者接受了术前超声引导下CNs注射，其他26名患者则没有接受。记录并分析耐受性、注射结果、切除转移淋巴结数量以及术后并发症。 CNs组中，26例患者的102个可疑不可触及病灶注射了CNs，再次手术时外科医生成功识别了102个病灶中的99个。切除淋巴结总数、中央区、侧区淋巴结阳性率分别为31.6%、31.2%、32.8%，显着高于对照组（P < 0.001、P < 0.001、P = 0.041）。此外，CNs组III、IV、V级阳性率分别为35.6%、21.9%、30.5%，显着高于对照组（P < 0.001，P = 0.005，P = 0.01）。此外，CNs组暂时性甲状旁腺功能减退症的发生率明显低于对照组（0% vs 26.9%，P = 0.021）。术前超声引导下 CNs 注射是再次手术期间定位转移淋巴结的安全有效的方法。
Due to the damaged anatomical structure and a large amount of fibrous and scar tissues in the surgical field, reoperation of papillary thyroid carcinoma is difficult. This study introduces a new method of locating metastatic lymph nodes during reoperation and evaluates the effectiveness and safety of the preoperative ultrasound-guided carbon nanoparticles (CNs) localization. This retrospective cohort study enrolled 52 patients who were diagnosed with lymph node metastasis by histopathology and underwent reoperation from October 2015 to February 2016. The modified radical neck dissection or selective neck node dissection was performed. A total of 26 patients underwent preoperative ultrasound-guided CNs injection, and other 26 patients did not. Tolerance, the result of injection, the number of resected metastatic lymph nodes, and postoperative complications were recorded and analyzed. In CNs group, 102 suspicious nonpalpable lesions in 26 patients were injected with CNs, and 99 of the 102 lesions were successfully identified by surgeon in the reoperation. The positive rate of resected lymph nodes in total, in the central compartment, and in the lateral compartment were 31.6%, 31.2%, and 32.8%, respectively, which was significantly higher than that in the control group (P < 0.001, P < 0.001, and P = 0.041). In addition, the positive rates of levels III, IV, and V in the CNs group were 35.6%, 21.9%, and 30.5%, respectively, which was significantly higher than that in the control group (P < 0.001, P = 0.005, and P = 0.01). In additional, in the CNs group, the rate of temporary hypoparathyroidism was significantly lower compared with the control group (0% vs 26.9%, P = 0.021). Preoperative ultrasound-guided CNs injection is a safe and effective method for localization of the metastatic lymph nodes during reoperation.