| Objective:Using Carbon Nanoparticles to trace Central District lymph nodes of patients with papillary thyroid carcinoma, to statistical the average number of central lymph nodes and the distribution of sub-regions; to evaluate the effectiveness of carbon nanoparticles suspension guide lymph node dissection in the surgical treatment of papillary carcinoma; Finally, analysis the factors of Single stove papillary thyroid carcinoma with central lymph node metastasis and discussed the range of central lymph node dissection.Methods:Collected the183cases cNO (lymph node-negative, meaning not found in clinical metastatic cervical lymph nodes) patients data to analyse,which with papillary thyroid cancer in September2013to January2014in Thyroid Disease Research Center, First Affiliated Hospital of Kunming Medical University, that were randomly divided into carbon nanoparticles groups and conventional surgery group. The cases of102carbon nanoparticles group, revealed bilateral thyroid intraoperative in the thyroid gland, under the next two film segments of slow injection of carbon nanoparticles0.05-0.1ml/side, and five minutes after the start of the injection thyroidectomy and bilateral central lymph node cleaning.The carbon nanoparticles group record the number of lymph nodes of the Central sub region in cleaning, and then classifing sub-region, the black dye and black dye did not bagging pathologic examination were sent after pathological examination results came out, the group recorded each sub-region central black dyed and dblack dyed did not transfer and record the number of lymph nodes metastasis in the black dye.81cases of conventional surgery group,only thyroidectomy and bilateral lymph node of central region to dissection, recording the number lymph nodes dissection of the Central sub region, and then bagging sub-region were sent to pathology, pathological examination after the results came out, and recorded the number of central lymph node each subdistrict transfer and did not transfer. The final numbers were comparing two groups lymph nodes metastasis and each sub-region.Finally, take the group of carbon nanoparticles single stove of cancer clinical data to analysis, and summed up the impact factor of lymph node metastasis in.the central region of single stove papillary thyroid carcinoma, so as to explore the scope of central lymph node dissection.Results:The injection of carbon nanoparticles led to no major complications such as anaphylaxis,the lymph nodes were stained black by carbon nanoparticle. carbon nanoparticles group have seized a total of lymph nodes is1511, the average per patient is (14.8±4.6) pieces, which stained lymph nodes of1110, the average per patient is (10.9±4.3) pieces, conventional surgery group have seized a total lymph nodes is659, with an average per case is (8.1±3.7) pieces, seized total lymph nodes groups was statistically significant difference (P<0.001), a group of black carbon nano-stained lymph nodes lymph nodes number and the total number of conventional surgery group difference was statistically significant (P<0.001);For the left side of the central lymph node, carbon nanoparticles group is (6.8±3.0) pieces per case, conventional surgery group is (3.7±2.5) pieces per case, the difference has statistically significant (P<0.001);For the right of the central lymph node, carbon nanoparticles group is (8.0±3.0) pieces per case, conventional surgery group (4.4±2.5) pieces per case, the difference has statistically significant (P<0.001);For the front right side of the central region lymph nodes of recurrent laryngeal nerve, carbon nanoparticles group is (6.4±2.5) pieces per case, conventional surgery group is (3.4±1.9) pieces per case, the difference has statistically significant (P<0.001);For the right side of the central region lymph nodes of recurrent laryngeal nerve, carbon nanoparticles group is (1.6±1.8) pieces per case, conventional surgery group is (1.0±1.6) pieces per case, the difference has statistically significant (P<0.05).For each groups sub-region lymph nodes seized the number of carbon nanoparticles was significantly higher than conventional surgery group. But the two groups for each sub-region relatively number of lymph node metastasis, the carbon nanoparticles group and the conventional surgery group showed no significant difference (P>0.05).In the carbon nanoparticles group, seized a total of stained lymph nodes is1110, which has120metastasis, the positive rate was10.81%, the seizure did not stained lymph nodes is401, where15transfer occurs, the positive rate was3.74%.the sensitivity of carbon nanoparticles tracer lymph nodes approximately73.46%(1110/1511), and the specificity of about10.81%(120/1110).After analysis, the group of black carbon nano-stained lymph nodes positive rate was significantly higher than that of not black dyed positive lymph nodes (P<0.001).carbon nanoparticles single lesion group had65cases of cancer, which occurs foci of ipsilateral central lymph node metastasis in17cases, the incidence of lymph node metastasis was26.15%, the occurrence of contralateral central lymph node metastasis foci in8cases, lymph nodes metastasis rate was12.31%,Where the foci of ipsilateral central lymph node metastasis clinicopathological factors include: gender (male patients more likely to have metastasis), tumor diameter greater than1cm, capsular invasion, infiltration of the trachea, recurrent laryngeal nerve infiltration;And the contralateral central lymph node metastasis clinicopathological factors include:foci of diameter greater than lcm, capsular invasion, infiltration trachea, recurrent laryngeal nerve invasion, lymph node metastasis-positive ipsilateral central region.Conclusions:1) Using carbon nanoparticles can significantly increase the number of lymph nodes, indicating that the level and extent of lymph node dissection in the surgical treatment of papillary thyroid cancer, and can provide the guiding significance of normative and thoroughness in lymph node dissection.2) Using Carbon Nanoparticles to trace Central District lymph nodes of patients with papillary thyroid carcinoma, to statistical the average number of central lymph nodes and the distribution of sub-regions,that can provide reasonable basis for thoroughness of central lymph node dissection.3) carbon nanoparticles have a strong lymph tendency, and can guide lymph node dissection, but it still can not determine as intraoperative lymph node metastasis.4) For a single stove papillary thyroid cancer patients, it is necessary when the line central lymph node dissection should combined the disease, such as tumor size, capsular invasion or not, tracheal invasion or not, the recurrent laryngeal nerve infiltration or not, ipsilateral central lymph node metastasis, etc, to consider whether to simultaneously had the contralateral central lymph node to dissection, which have great significance to prevent inadequate medical and avoid excessive medical. |
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