纳米碳示踪剂用于cN0T1/T2期甲状腺乳头状癌中央区淋巴结清扫的效果及影响因素

目的探讨纳米碳示踪剂应用于cN0T1/T2期甲状腺乳头状癌中央区淋巴结清扫的效果及影响因素。 方法选择2015年1月至2017年12月期间接受手术治疗的cN0T1/T2期甲状腺乳头状癌患者153例作为研究对象，随机数字表法分为踪剂组(76例)和常规组(77例)，其中踪剂组接受术中注射纳米碳示踪剂并进行中央区淋巴结清扫，常规组接受常规中央区淋巴结清扫。采用SPSS 21.0进行临床数据分析，围术期指标及淋巴结清扫数量等计量资料用( ±s)表示，独立t检验；术后并发症、复发率采用χ²检验；预后情况绘制kaplanmeier生存曲线，对淋巴结检出因素进行单因素和多因素logistic回归分析，P<0.05差异有统计学意义。 结果踪剂组人均清扫淋巴结数量为(9.3±2.3)枚、淋巴结检出阳性率95.1%，均明显优于常规组(P<0.05)。踪剂组在术后1 d、3 d、术后3个月血钙和PTH水平，明显高于常规组(P<0.05)。踪剂组甲状旁腺受损情况明显低于常规组(P<0.05)；两组在喉返神经损伤情况比较，差异无统计学意义(P>0.05)。踪剂组复发率(15.8%)明显低于常规组(29.9%), P<0.05。两组组内复发与未复发患者淋巴结清扫数量比较，差异均具有统计学意义(P<0.05)。所有患者的24个月总生存率为91.5%，不同淋巴结清扫数量与生存预后无相关性。体重指数、淋巴结平均直径、医师经验是纳米碳示踪剂检出淋巴结清扫数量的独立危险因素(P<0.05)。 结论纳米碳示踪剂能够明显增加cN0T1/T2期甲状腺乳头状癌中央区淋巴结清扫数量，同时对预防手术并发症及术后复发有积极作用。

Effect and influencing factors of nano-carbon tracer on lymph node dissection in central area of cN0T1/T2 stage papillary thyroid carcinoma

ObjectiveTo investigate the effect and influencing factors of nano-carbon tracer on lymph node dissection in the central area of cN0T1/T2 stage papillary thyroid carcinoma. Methods153 patients with cN0T1 / T2 stage thyroid papillary carcinoma who underwent surgical treatment from January 2015 to December 2017 were selected as the research subjects. The random number table method was used to divide the tracer group (76 cases) and the routine group (77 cases)by 1∶1 ratio, the tracer group received intraoperative injection of nano-carbon tracer and central lymph node dissection, but the routine group received routine central lymph node dissection only. SPSS 21.0 were used for clinical data analysis. Measurement data such as perioperative indicators and number of lymph node dissections were expressed as ( ±s), and compared with independent t test; postoperative complications and recurrence rate were measured by χ² tests; prognosis was plotted by kaplanmeier survival Curve, the univariate and multivariate logistic regression analysis was used for the detected factors of lymph nodes, P<0.05 was statistically significant. ResultsThe number of lymph nodes per person in the tracer group was (9.3±2.3), and the positive rate of lymph node detection was 95.1%, which were significantly better than those in the routine group (P<0.05). The serum calcium and PTH levels in the tracer group were significantly higher than the routine group at 1 and 3 days and 3 months after surgery (P<0.05). The damage of the parathyroid glands in the tracer group was significantly lower than that in the conventional group (P<0.05). The relapse rate in the tracer group (15.8%) was significantly lower than the routine group (29.9%), and the difference was statistically significant (P<0.05). The 24-month overall survival rate of all patients was 91.5%. There was no significant difference in survival prognosis between different numbers of lymph node dissections (P<0.05). Multivariate logistic regression analysis showed, mean lymph node diameter, and physician experience were independent risk factors for the number of lymph node dissections detected by nano-carbon tracers (P<0.05). ConclusionNano-carbon tracer can significantly increase the number of lymph node dissections in the central area of cN0T1/T2 stage papillary thyroid carcinoma, and it has a positive effect on the prevention of surgical complications and postoperative recurrence.