發(fā)布時間：2018-06-15 08:36

  本文選題：納米碳 + 甲狀腺癌�。� 參考：《大連醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探討納米碳混懸液示蹤前哨淋巴結(jié)活檢在cNO分化型甲狀腺癌術(shù)中的應(yīng)用價值,評價其臨床療效及應(yīng)用效果,以指導(dǎo)臨床工作。方法:選取大連大學(xué)附屬中山醫(yī)院乳腺甲狀腺科2013年1月～2014年10月行手術(shù)治療的cNO分化型甲狀腺癌患者96例作為研究對象,患者均經(jīng)術(shù)前細(xì)針抽吸活檢或術(shù)中冰凍診斷為分化型甲狀腺癌,術(shù)前頸部CT增強檢查與彩超檢查均未見頸部淋巴結(jié)轉(zhuǎn)移,均為首次接受手術(shù)治療患者,且無甲狀腺切除術(shù)的禁忌癥。對上述患者的臨床資料進行回顧性分析,其中術(shù)中使用納米碳混懸液病例設(shè)為淋巴結(jié)示蹤組(示蹤組),同期術(shù)中未使用納米碳混懸液病例設(shè)為空白對照組(對照組),各48例。比較淋巴結(jié)清掃數(shù)目、手術(shù)相關(guān)指標(biāo)(手術(shù)時間、術(shù)中出血量、術(shù)后引流量)、甲狀旁腺功能、術(shù)后24個月回訪頸部淋巴結(jié)轉(zhuǎn)移情況。結(jié)果:示蹤組手術(shù)時間為(80.7±11.4)min、術(shù)中出血量為(41.3±8.4)ml、術(shù)后引流量為(72.4± 12.3)ml;對照組手術(shù)時間為(84.6± 12.4)min、術(shù)中出血量為(43.7±9.1)ml、術(shù)后引流量為(74.5±13.9)mml。兩組上述各指標(biāo)比較均無統(tǒng)計學(xué)意義(P0.05);示蹤組術(shù)后低鈣血癥發(fā)生率為4.2%(2/48),對照組為20.8%(10/48),組間比較有統(tǒng)計學(xué)差異(P0.05);示蹤組術(shù)后1d甲狀旁腺激素(PTH)水平為(35.36± 18.35)ng/L,對照組為(26.58±15.80)ng/L,比較有統(tǒng)計學(xué)差異(P0.05);淋巴結(jié)示蹤組術(shù)后1周PTH水平為(37.67 ±17.29)ng/L,對照組為(28.06±17.15)ng/L,組間比較有統(tǒng)計學(xué)差異(P0.01)。示蹤組行中央?yún)^(qū)淋巴結(jié)清掃例數(shù)15例,對照組全部行預(yù)防性中央組淋巴結(jié)清掃。示蹤組行中央?yún)^(qū)淋巴結(jié)清掃者切除淋巴結(jié)的數(shù)目為(9.40±2.35)枚,對照組為(7.86±2.06)枚,組間比較有統(tǒng)計學(xué)差異(P0.01)。術(shù)后門診隨訪24個月顯示兩組術(shù)后72h發(fā)生甲狀旁腺功能低下或低鈣血癥者其血PTH、Ca+水平均恢復(fù)至正常范圍,示蹤組和對照組的局部復(fù)發(fā)率和遠(yuǎn)處轉(zhuǎn)移發(fā)生率比較差異均無統(tǒng)計學(xué)意義(P0.05),兩組均未出現(xiàn)永久性甲狀旁腺功能低下和喉返神經(jīng)損傷病例。結(jié)論:前哨淋巴結(jié)活檢可發(fā)現(xiàn)早期轉(zhuǎn)移的頸部淋巴結(jié),對是否行中央?yún)^(qū)淋巴結(jié)清掃具有指導(dǎo)意義;手術(shù)時間、術(shù)后引流量及術(shù)后并發(fā)癥并沒因納米碳混懸液的使用而增加,相反,淋巴結(jié)清掃率的提高,降低了病人二次手術(shù)的風(fēng)險,同時有助于識別甲狀旁腺并保護甲狀旁腺功能,具有重要臨床應(yīng)用價值。
[Abstract]:Objective: to evaluate the value of sentinel lymph node biopsy with nano-carbon suspension in the operation of CNO differentiated thyroid carcinoma. Methods: Ninety-six patients with CNO differentiated thyroid carcinoma were selected from Department of Breast thyroid of Zhongshan Hospital affiliated to Dalian University from January 2013 to October 2014. All the patients were diagnosed as differentiated thyroid carcinoma by preoperative fine needle aspiration biopsy or intraoperative freezing. There was no cervical lymph node metastasis on CT enhanced scan and color Doppler ultrasonography before operation. All patients were treated with surgery for the first time. There was no contraindication for thyroidectomy. The clinical data of the above patients were retrospectively analyzed. The cases with nano-carbon suspension were divided into lymph node tracer group (tracer group) and blank control group (control group, 48 cases, respectively). The number of lymph nodes dissection, operative parameters (operation time, intraoperative blood loss, postoperative drainage, parathyroid function, and neck lymph node metastasis 24 months after operation) were compared. Results: in the tracer group, the operative time was 80.7 鹵11.4 min, the intraoperative bleeding volume was 41.3 鹵8.4 ml, the postoperative drainage volume was 72.4 鹵12.3 ml, in the control group the operative time was 84.6 鹵12.4 min, the intraoperative bleeding volume was 43.7 鹵9.1 ml, and the postoperative drainage volume was 74.5 鹵13.9mml. In the tracer group, the incidence of hypocalcemia was 4.22 / 48, the control group was 20.8 / 10 / 48, the level of PTH in the tracer group was 35.36 鹵18.35 ng / L, and in the control group was 26.58 鹵15.80 ng / L, the level of PTH in the tracer group was 35.36 鹵18.35 ng / L on the 1st day after operation, and that in the control group was 26.58 鹵15.80 ng / L, respectively. The level of PTH was 37.67 鹵17.29 ng / L in the lymph node tracer group and 28.06 鹵17.15 ng / L in the control group (P < 0.01). There were 15 cases of central lymph node dissection in tracer group and 15 cases in control group. The number of dissected lymph nodes was 9.40 鹵2.35 in the tracer group and 7.86 鹵2.06 in the control group. There was significant difference between the two groups (P 0.01). Follow-up 24 months after operation showed that the serum PTH Ca levels of patients with hypoparathyroidism or hypocalcemia in both groups recovered to normal range 72 hours after operation. There was no significant difference in local recurrence rate and distant metastasis rate between tracer group and control group (P 0.05). There were no cases of permanent hypoparathyroidism and recurrent laryngeal nerve injury in both groups. Conclusion: sentinel lymph node biopsy can find the cervical lymph nodes with early metastasis, which is helpful to the central lymph node dissection, and the operative time, postoperative drainage and postoperative complications are not increased by the use of nano-carbon suspension. On the contrary, the increase of lymph node dissection rate reduces the risk of secondary operation, and helps to identify parathyroid gland and protect parathyroid function, which has important clinical application value.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R736.1

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