The role of carbon nanoparticles in identifying lymph nodes and preserving parathyroid in total endoscopic surgery of thyroid carcinoma
The role of carbon nanoparticles in identifying lymph nodes and preserving parathyroid in total endoscopic surgery of thyroid carcinoma
复制标题
纳米碳在甲状腺癌全内镜手术中识别淋巴结和保存甲状旁腺的作用
DOI：
10.1007/s00464-014-4020-x
复制
发表时间：
2015-10-01
影响因子：
3.1
通讯作者：
Qiu, Ming
中科院分区：
文献类型：
--
作者：
Wang, Bin;Qiu, Nian-cun;Qiu, Ming
目的评价纳米碳（CN）在内镜下甲状腺全切除术（ETT）联合中央颈清扫术（CND）中识别淋巴结和保留甲状旁腺的效果，并进一步探讨CN对术后甲状旁腺功能恢复的作用。主要结果测量是病理结果（例如，偶然切除的甲状旁腺和清扫的淋巴结的量）和随访结果[例如，血清钙和甲状旁腺激素（PTH）水平的恢复]。次要终点为神经肌肉症状发生率、住院期间术后激素测定和淋巴结转移率。结果CN组共检出淋巴结193个，对照组共检出淋巴结123个。CN组中检测到的淋巴结平均数量显著高于对照组（P = 0.009）。甲状旁腺存在于5例患者的甲状腺或中央淋巴结标本中，均为对照组。与CN组相比，对照组的偶发性甲状旁腺切除术发生率相对较高（P = 0.023）。与CN组相比，对照组中感觉异常的发生率更高，即使没有统计学显著性。在随访期间，CN组的血清钙水平高于对照组;但无统计学显著差异。对于血清PTH水平，CN组迅速恢复到术前水平，而对照组稳步攀升至正常范围。CN组术后1周和1个月血清PTH水平明显高于对照组。结论CN在CND ETT中具有保护甲状旁腺、彻底清扫淋巴结和促进甲状旁腺快速恢复的作用（ChiCTR-TRC-14005042）
Aim To evaluate the efficacy of carbon nanoparticles (CNs) in identifying lymph nodes and preserving parathyroids in endoscopic total thyroidectomy (ETT) with central neck dissection (CND), and to further explore the role of CNs in recovering postoperative parathyroid function.Method Fifty-five patients with papillary thyroid carcinoma were randomized to either CN group (n = 28) or control group (n = 27). The primary outcome measures were pathological results (e.g., amount of incidental removed parathyroids and lymph nodes dissected) and follow-up results [e.g., recovery of serum calcium and parathyroid hormone (PTH) levels]. The secondary end-points were the rates of neuromuscular symptoms, in-hospital postoperative hormonal assay, and lymph node metastases.Results A total of 193 lymph nodes in the CN group and 123 lymph nodes in the control group were detected. The mean number of detected lymph nodes was significantly higher in the CN group than in the control group (P = 0.009). Parathyroids were present in the thyroid or central nodal specimens of five patients, which were all in the control group. The control group had a relatively higher incidence of incidental parathyroidectomy compared to the CN group (P = 0.023). Compared to the CN group, the incidence of paresthesia was higher in the control group even if not statistically significant. During follow-up, the serum calcium levels were higher in the CN group than in the control group; however, there was no statistically significant difference. For the serum PTH levels, the CN group recovered rapidly to the preoperative levels, whereas the control group climbed steadily to the normal range. The serum PTH levels in the CN group were apparently higher than in the control group at 1 week and 1 month postoperatively.Conclusion CNs play an important role in protecting parathyroid glands, dissecting lymph nodes thoroughly, and promoting rapid recovery of parathyroid in ETT with CND (ChiCTR-TRC-14005042)