Analysis of the factors for the lymph node metastasis in rⅥb region of thyroid micropapillary carcinoma and the application value of intraoperative nano-carbon
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摘要: 目的 探讨rⅥb区淋巴结转移与甲状腺微小乳头状癌病理特征的关系及术中使用纳米碳对手术及rⅥb区淋巴结清扫的应用价值。方法 根据175例甲状腺微小乳头状癌术中是否使用纳米碳，分析纳米碳使用对手术时间、中央区、rⅥb区淋巴结清扫出的数量、术后低钙症状和声嘶情况发生的影响; 将rⅥb区淋巴结转移与否与甲状腺微小乳头状癌病理特征进行统计分析; ROC曲线分析彩超学特征在rⅥb区淋巴结阳性率评估中的价值。结果 甲状腺微小乳头状癌术中使用纳米碳，可提高中央区、rⅥb区淋巴结清扫出的数量，降低甲状旁腺损伤的概率，差异有统计学意义; rⅥb区淋巴结阳性率与年龄、性别、结节纵横比及微小钙化无关，与肿瘤大小、多灶性及是否侵犯被膜有关; 以上述3种彩超相关特征建立rⅥb区淋巴结转移评估模型，ROC曲线分析表明其具有较高的应用价值。结论 肿瘤大小、多灶性及是否侵犯被膜是甲状腺微小乳头状癌rⅥb区淋巴结转移的危险因素，术中使用纳米碳可提高颈部淋巴结清扫的彻底性并增加手术安全性。Abstract: Objective To investigate the relationship between lymph node metastasis in rⅥb region and pathological features of papillary thyroid microcarcinoma, and the application value of carbon nanoparticles in the operation for lymph node dissection in rⅥb region.Method One hundred and seventy-five patients were divided into carbon nanoparticles group and the control group depending on whether carbon nanoparticles were used in the operation. The operation time, the number of central lymph node, the number of rⅥb region lymph node, hypocalcaemia symptom complex and hoarseness after the operaion were compared between the two groups. The lymph node metastasis in the rⅥb region and the pathological features of papillary thyroid microcarcinoma were statistically analyzed.Result The amount of lymph nodes in Central District and rⅥb region was increased and the probability of parathyroid gland injury was decreased by using nano-carbon. The positive rate of lymph nodes in rⅥb region was not related to age, sex, aspect ratio of nodules and microcalcification, but was related to the tumor size, multifoci and the invasion of the capsule. The evaluation model of lymph node metastasis in rⅥb region was established based on the above three correlative features of color doppler ultrasound. The ROC curve analysis showed that the model had high application value.Conclusion The tumor size, multiple foci and capsule invasion are risk factors for lymph node metastasis in rⅥb region of thyroid micropapillary carcinoma.
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表 1 2组手术时间、淋巴结检出数目、术后手足麻木、声嘶情况
组别 例数 手术时间/min 中央区淋巴结个数
(枚/例)rⅥb区淋巴结个数
(枚/例)术后手足麻木
/例术后声嘶
/例纳米碳组 102 131.17±9.28 8.27±1.59 3.28±0.49 6 5 对照组 73 129.25±9.13 5.43±1.42 1.18±0.32 12 11 T(χ2) 0.72 12.24 6.45 5.14 5.29 P 0.57 < 0.01 0.01 0.02 0.02 
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表 2 rⅥb区淋巴结阳性率与甲状腺微小乳头状癌病理特征的关系
病理学特征 例数 rⅥb淋巴结 χ2 P (+) (-) 性别 男 37 13 24 0.00 0.97 女 138 48 90 年龄/岁 < 45 89 34 55 0.89 0.35 ≥45 86 27 59 结节大小/mm ≥5 109 49 60 12.98 0.00 < 5 66 12 54 多灶性 单灶 102 15 87 43.73 0.00 多灶 73 46 27 结节纵横比 < 1 51 16 35 0.39 0.54 ≥1 124 45 79 微小钙化 有 127 41 86 1.35 0.25 无 48 20 28 病灶血供丰富 是 34 12 22 0.00 0.95 否 141 49 92 是否侵犯被膜 是 22 15 7 12.31 0.00 否 153 46 107 是否合并桥本 是 32 10 22 0.22 0.64 否 143 51 92 病灶位置 上1/2 105 31 74 3.29 0.07 下1/2 70 30 40
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