| Objective：1.Study the value of clinical application of nano carbon lymph tracertechnology in operation of thyroid carcinoma lymph node dissection for discrimination,protection of the parathyroid glands.；2.By intraoperative lymph black dye andpostoperative pathological examination results, to understand the carbon nano lymphtracer technique on neck lymph node dissection significance；3. To investigate thefeasibility of ultrasound guided nano carbon intrathyroidal injection in the operation ofthyroid cancer before operation.Methods：By using the method of prospective, random sampling, choose theinclusion criteria patients of the2013March to2014year in May in laparoscopicsurgery in the First Affiliated Hospital of Dalian Medical University, except forprevious thyroid operation, with serious complications or mental illness not operationtreatment, non-papillary thyroid carcinoma, associated with cervical lymph nodemetastasis were randomly divided into experiment group and observation group. Theexperimental group underwent nano carbon intrathyroidal injection at the ultrasoundguide at one day before surgery,received routine operation therapy; the control grouponly underwent conventional operation treatment. The two groups were observed inpatients with blood loss, operative time, postoperative hospital stay, parathyroidmistakenly cut, central lymph node clearance and metastasis, postoperative hypocalcemia symptoms and the incidence of postoperative serum calcium (Ca),parathyroid hormone (PTH) decreased by transient.Results:1.General: patients who met the inclusion criteria of40cases, the experimentalgroup and the control group with20cases in each. The experimental group with4maleand16female, mean age47.90±10.12years old; the control group with8male and12female, mean age49.50±12.40years old. After testing, two groups of gender, age,preoperative serum calcium, preoperative PTH level is P>0.05, no significant differencebetween the two groups were comparable.2.The experimental group and the control group in operative time, blood loss,postoperative hospital stay compared：the experimental group，s average operation timeapplication of nano carbon tracer was170.00±19.47min, the control group was160.50±13.85min, the average intraoperative blood loss was23.00±8.01ml, the control groupwas25.00±13.18ml, the average length of the experimental group were5.40±1.23days after operation, the control group4.80±0.77days, the experimental group and thecontrol group in these three areas, the difference was not statistically significance (P>0.05).3.The comparative of parathyroid protection, central lymph node dissection,aswell as the number of lymph nodes metastasis between experimental group and controlgroup:the experimental group had1case of inadvertent parathyroidectomy, mistakenlycut rate was5%, control group7cases of false cut, cut by accident rate is35%, theexperimental group mistakenly cut rate significantly less than the control group, whichhave statistical significance (P<0.05); the experimental group clear the number of thecentral lymph node as many as152, average7.60±2.52, control group were94,average4.70±2.52, the removal of the central group of lymph node number inexperimental group are more than the control group, with significant difference betweentwo groups (P<0.05); metastasis rate of experimental group was25%and the controlgroup was10%, there was no significant difference in two groups (P>0.05).4.The comparative between experimental group and control group on hypocalcemi a symptoms,a transient lowering of serum calcium,serum PTH reduced by temporary after surgery:the number of patients who happen postoperative hypocalcemia symptomsbetween the experimental group and control group were in2cases (10%) and6cases (30%) respectively, no significant difference (P>0.05); The postoperative complicationsof experiment in transient hypocalcemia have3cases (15%),7cases in the control group (35%), no significant difference between the two groups (P>0.05); experimental group patients with a temporary reduction in PTH were3cases (15%), the control group was8cases (40%), two groups had no significant significant differences (P>0.05).Conclusion:1. The application of nano carbon tracer in operation of thyroid carcinoma will notextend the operative time, blood loss, postoperative hospital stay, nano-carbon tracer isa safe approach.2.The application of nano carbon tracer in operation of thyroid carcinoma canincrease the central lymph node dissection number.3. The application of nano carbon tracer in operation of thyroid carcinoma canreduce the error of parathyroid cut rate, protect the parathyroid function. |
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