纳米炭示踪剂在机器人甲状腺癌淋巴结清扫中的应用
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1.锦州医科大学研究生院,辽宁 锦州 121001;2.中国人民解放军联勤保障部队第九六〇医院 甲状腺乳腺外科,山东 济南 250031

作者简介:

刘旭,锦州医科大学研究生院硕士研究生,主要从事甲状腺乳腺临床方面的研究。

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Application carbon nanoparticle tracer for lymph node dissection in robotic thyroidectomy
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1.Graduate School, Jinzhou Medical University, Jinzhou Liaoning 121001, China;2.Department of Thyroid and Breast Surgery, the 960th ospital of Joint Logistic Support Force of PLA, Jinan 250031, China

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    摘要:

    背景与目的 纳米炭作为新型淋巴结示踪剂,已广泛应用于传统的甲状腺癌根治术中。目前,微创手术是时代的主题,机器人的应用使得微创手术获得更好的发展,其安全性、有效性得到广泛认证。因此,本研究探讨在机器人甲状腺癌根治术中应用纳米炭示踪剂对淋巴结清扫的效果,以期为临床应用提供参考。方法 回顾性分析294例行达芬奇机器人甲状腺乳头状癌根治术患者资料,其中160例术中使用纳米炭示踪剂(研究组),134例未使用纳米炭(对照组)。比较两组术后中央区及颈侧区淋巴结清扫总数、阳性淋巴结数目、淋巴结清扫手术时间及颈侧区淋巴结清扫并发症发生率。结果 两组间年龄、性别、肿瘤大小、TNM分期、浸润被膜与否方面差异均无统计学意义(均P>0.05)。研究组平均中央区的淋巴结检出数(13.46枚vs. 8.66枚)及其平均阳性淋巴结检出数(3.38枚vs. 2.31枚)均明显高于对照组(均P<0.05);研究组平均颈侧区淋巴结检出数高于对照组(15.21枚vs. 1.44枚,P<0.05),但其平均阳性淋巴结检出数与对照组差异无统计学意义(P>0.05)。研究组行平均单侧中央区淋巴结清扫时间(77.08 min vs. 88.83 min)、双侧中央区清扫时间(128.29 min vs. 160.11 min)、中央区+颈侧区清扫时间(199.93 min vs. 221.64 min)均明显少于对照组(均P<0.05),两组各项颈侧区淋巴结清扫术后并发症发生率差异均无统计学意义(均P>0.05)。结论 机器人甲状腺癌手术应用纳米炭可显著增加检获淋巴结的数量,提高中央区淋巴结的检出阳性率,并可以缩短淋巴结清扫时间。

    Abstract:

    Background and Aims As a new lymph tracer, nanocarbons have been widely used in traditional thyroidectomy. Minimally invasive surgery is nowadays the theme of surgery. Robotic technology has spurred the development of minimally invasive surgery, and its safety and effectiveness have been widely recognized. This study was conducted to investigate the effect of using a carbon nanoparticle tracer for lymph node dissection in robotic thyroidectomy to provide a reference for clinical use.Methods The data of 294 patients with papillary thyroid carcinoma who underwent radical resection by Da Vinci robotic surgical system were retrospectively analyzed. Of the patients, carbon nanoparticle tracer was used in 160 cases (observation group) and not in 134 cases (control group) during surgery. The total number of central and lateral cervical lymph node dissections, number of positive lymph nodes, operative time for lymph node dissection, and incidence of complications of lateral cervical lymph node dissection were compared between the two groups.Results There were no significant differences in age, gender, tumor size, TNM stage, and the presence or absence of capsular invasion between the two groups (all P>0.05). In observation group versus control group, the average number of central lymph nodes dissected (13.46 vs. 8.66) and the average number of positive lymph nodes detected (3.38 vs. 2.31) were significantly higher (both P<0.05); the average number of lateral cervical lymph nodes dissected was significantly higher (15.21 vs. 1.44, P<0.05), but its average number of positive lymph nodes detected showed no significant difference (P>0.05). The operative time for unilateral central lymph node dissection (77.08 min vs. 88.83 min), bilateral central lymph node dissection (128.29 min vs.160.11 min), and for central plus lateral cervical lymph node dissection (199.93 min vs. 221.64 min) were significantly reduced in observation group compared with control group (all P<0.05). There were no significant differences in incidence rates of all specific postoperative complications following lateral cervical lymph node dissection between the two groups (all P>0.05).Conclusion The application of nanocarbon in robotic thyroid cancer surgery can significantly increase the number of lymph nodes detected, improve the detection rate of positive central lymph nodes, and shorten the operative time for neck dissection.

    图1 术中照片 A:中央区淋巴结清扫;B:颈侧区淋巴结清扫Fig.1 Intraoperative views A: Central lymph node dissection; B: Lateral cervical lymph node dissection
    表 4 颈侧区清扫术后并发症[n(%)]Table 4 Postoperative complications of lateral neck dissection [n (%)]
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刘旭,于芳,王刚,侯蕾,范子义,贺青卿.纳米炭示踪剂在机器人甲状腺癌淋巴结清扫中的应用[J].中国普通外科杂志,2022,31(11):1445-1452.
DOI:10.7659/j. issn.1005-6947.2022.11.006

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  • 收稿日期:2022-06-10
  • 最后修改日期:2022-10-10
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  • 在线发布日期: 2022-12-07