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目的:研究纳米炭在临床颈淋巴结阴性(cN0)分化型甲状腺癌(DTC)手术中的应用价值。方法:选择90例cN0DTC患者,随机分为2组:使用纳米炭组和未使用组各45例,均行全甲状腺切除术加患侧中央区淋巴结清扫,统计中央区淋巴结清扫个数、微小淋巴结个数、转移淋巴结个数、转移例数、染色淋巴结个数及转移情况、甲状旁腺误切个数,监测术后24,48,72h血钙、血磷、甲状旁腺激素的水平,记录甲状旁腺功能减退及喉返神经、喉上神经的损伤情况。结果:纳米炭组中央区淋巴结清扫总数、微小淋巴结、转移淋巴结个数、淋巴结转移例数、染色淋巴结转移率均高于对照组,甲状旁腺误切情况及暂时性甲状旁腺功能减退均低于对照组,差异有统计学意义(P<0.05)。永久性甲状旁腺功能减退、喉返神经损伤、喉上神经损伤发生率差异无统计学意义(P>0.05)。术后两组患者随访12-22个月,均无复发及转移、死亡发生。结论:纳米炭可明显提高cN0DTC患者中央区淋巴结的清扫数目,尤其微小(≤2mm)淋巴结的数目。染色淋巴结转移率较高,对肿瘤的准确分期及局部控制有所帮助;同时可保护甲状旁腺,减少甲状旁腺功能减退的发生。
Objective: To study the application value of nanometer carbon in clinical cervical lymph node-negative (cN0) differentiated thyroid carcinoma (DTC). Methods: Ninety patients with cN0DTC were randomly divided into 2 groups: 45 cases were treated with nanocarbon and unused group. All patients underwent total thyroidectomy plus central lymph node dissection in the affected area. The number of lymph node dissection in the central area, The number of metastatic lymph nodes, the number of metastatic lymph nodes, the number of metastatic lymph nodes, the number of metastatic lymph nodes and the number of metastatic parathyroid glands. The levels of serum calcium, phosphorus and parathyroid hormone at 24, 48 and 72 h postoperatively were recorded and recorded Parathyroid dysfunction and recurrent laryngeal nerve, laryngeal nerve damage. Results: The total number of lymph nodes, tiny lymph nodes, the number of metastatic lymph nodes, the number of lymph node metastases and the rate of lymph node metastasis in the central area of the nanocarbon group were significantly higher than those in the control group. The parathyroid misdiagnosis and transient hypoparathyroidism were both low In the control group, the difference was statistically significant (P <0.05). There was no significant difference in the incidence of permanent hypoparathyroidism, recurrent laryngeal nerve injury and laryngeal nerve injury (P> 0.05). Two groups of patients were followed up for 12-22 months, no recurrence and metastasis, the death occurred. Conclusion: Nanocarbon can significantly improve the number of lymph nodes in the central area of patients with cN0DTC, especially the number of small (≤2mm) lymph nodes. High staining rate of lymph node metastasis, the exact stage of the tumor and local control help; the same time can protect the parathyroid gland, reducing the incidence of hypoparathyroidism.