目的：探讨纳米炭示踪在腔镜下甲状腺癌手术淋巴结清扫及甲状旁腺保护方面的应用价值。方法：选取2013年1月—2015年1月中南大学湘雅医院126例行腔镜手术的甲状腺乳头状癌患者，随机分为对照组（40例）、亚甲蓝组（41例）以及纳米炭组（45例）。对照组行常规手术，后两组术中分别注射相应示踪剂。统计各组淋巴结和转移淋巴结的检获数目及甲状旁腺的误切情况，并对亚甲蓝组与纳米炭组染色与未染色的淋巴结行病理检查。结果：注射示踪剂的两组均未出现过敏反应。纳米炭组检获的淋巴结数明显高于对照组（t=5.164，P<0.05）及亚甲蓝组（t=4.763，P<0.05），且纳米炭组微小淋巴结（<2 mm）的检获率要高于亚甲蓝组（29.3% vs. 13.2%；χ2=18.231，P<0.05），而对照组未检获微小淋巴结。3组的淋巴结癌转移率差异无统计学意义（P>0.05），但纳米炭组的癌转移淋巴结染色率要高于亚甲蓝组（92.2% vs. 78.8%；χ2=5.605，P<0.05）。对照组发现甲状旁腺18枚，而使用染色剂的两组均未出现甲状旁腺误切。结论：纳米炭在淋巴结趋向性以及示踪效果方面都要优于亚甲蓝，可以帮助术者进行更加彻底的甲状腺癌淋巴结清扫，此外，对甲状旁腺也起到了有效的保护作用，推荐临床使用。
Clinical application of carbon nanoparticles in endoscopic surgery for thyroid carcinoma
Objective: To investigate the application value of nano-carbon tracing in lymph node dissection and protection of parathyroids during endoscopic surgery for thyroid carcinoma. Methods: One hundred and twenty-six patients with papillary thyroid carcinoma undergoing endoscopic thyroid surgery during January 2013 to January 2015 in Xiangya Hospital, Central South University were enrolled and randomly assigned to control group (40 cases), methylene blue group (41 cases) and carbon nanoparticle group (45 cases). Patients in control group underwent regular operation, while those in the other two groups were injected with corresponding tracer during operation. The number of retrieved lymph nodes and metastatic lymph nodes and inadvertent parathyroidectomy in each group were calculated. Further, both stained and unstained lymph node specimens from methylene blue group and carbon nanoparticle group were pathologically examined. Results: No anaphylactic reactions occured in the two groups of patients receiving tracer injection. The number of detected lymph nodes in carbon nanoparticle group was significantly higher than that in either control group (t=5.164, P<0.05) or methylene blue group (t=4.763, P<0.05). Further, the detection rate of tiny lymph nodes (<2 mm) in carbon nanoparticle group was significantly higher than that in methylene blue group (29.3% vs. 13.2%; χ2=18.231, P<0.05), while no tiny lymph nodes were detected in control group. There was no significant difference in rate of lymph node metastases among the three groups (P>0.05), but the staining rate of metastatic lymph nodes in carbon nanoparticle group was significantly higher than that in methylene blue group (92.2% vs. 78.8%; χ2=5.605, P<0.05). Eighteen inadvertently resected parathyroid glands were found in control group, while no inadvertent removal of parathyroid glands occurred in both methylene blue and carbon nanoparticle groups. Conclusion: Nano-carbon is superior to methylene blue in targeting lymph nodes and the tracing effect may help surgeons conduct a more thorough lymph node dissection. Meanwhile, its application can effectively avoid inadvertent parathyroidectomy. So, its clinical application is recommended.