The Application Of CNS In Radical Surgery Of PMC

Objective: Before or in the radical surgery of PMC, inject CNS tocarry out the dye tracer of the thyroid and the cervical lymph nodes,observe the effect of the dye tracer of the thyroid and the cervical lymphnodes in the radical surgery of PMC after injecting CNS. Then identifyand protect the parathyroid. And study the application value of CNS inradical surgery of PMC. Methods: Select80patients who had the radicalsurgery of PMC to do the Prospective clinical study at The ThyroidVascular Surgery, Sichuan Academy of Medical Sciences, SichuanProvincial People’s Hospital from February2012to October2013.Thepatients who are greater than18and less than45, include10males and70females, and the proportion of male and female is1:7. The patientswere divided into2groups, test group and control group,40cases in eachgroup. According to the different injection time, the test group wasdivided into group A, injected before the surgery, and group B, injected inthe surgery,20cases in each group. We chose one point each at the upperpole and lower pole of thyroid to inject CNS. In group A, the day beforethe surgery.We injected CNS under ultrasound at the points of the upperpole and lower pole of thyroid, each0.1ml, a total of0.2ml. In groupB,we injected CNS at the points of the upper pole and lower pole ofthyroid after exposing thyroid in the surgery, each0.1ml, a total of0.2ml.While we did conventional surgery without injecting CNS incontrol group. In this study, we all chose the same Operative method,Total thyroidectomy+lateral central lymph node dissection. During thesurgery, we observed whether the CNS had extravasated, and checked theparathyroid had been dyed or not. We also made frozen section and pathological section to confirm that whether parathyroid had been cutincorrectly. We examined the level of Serum calcium and parathyroidhormone of every patient before and after surgery, and all the cases werefollowed up for more than6months. We counted the number of thelymph nodes which had been cut or dyed in each group, group A andgroup B. Then we sent lymph nodes specimens to doing pathologicalexaminations, to know about the dyeing of the lymph nodes and theirmetastasis. Results: During this study, allergy and un-well reactionsdidn’t appear on these patients after we injected CNS before and in thesurgery. We found thyroid and cervical lymph nodes had been blackened,but parathyroid had not been dyed. After the surgery,15patients startedto appear hypoparathyroidism temporarily,10cases in the control group,and5cases in the test group, in which2patients in group A and3patientsin group B. There were no cases appeared hypoparathyroidismpermanently. CNS extravasation only appeared at one patients in group A,while6patients in group B, that mean the extravasation rate in groupB was higher than group A. There was significant difference between thetwo groups. According to frozen section and pathological section, therewere11parathyroids found to been cut by mistake, in which3cases werein the test group, the other8cases were in the control group, the rate ofthe cases whose parathyroid had been cut by mistake in the test groupwas lower than those in the control group. And there was significantdifference between the two groups. There were522Region Ⅵ lymphnodes cut in the test group and the control group, including308lymphnodes in the test group,7.7every cases, and214in the control group,inwhich5.35lymph nodes in every case. The number of average lymphnodes in the test group was more than which were in the control group,and there was significant difference between the two groups. We cut308lymph nodes in the test group, including223dyed lymph nodes, in which were68lymph nodes metastasated while155not. And the other85lymph nodes had not been dyed, in which26lymph nodes had beenmetastasated while59not. There was no significant difference betweenthe two groups. Conclusions:1）.The tropism of CNS at lymph nodes isvery powerful, and the trace of lymph nodes is very clear. So it is veryeasy to make lymph nodes dyed while parathyroid not. We can use thistechnology in the radical surgery of PMC to identify and protectparathyroid.2）.Making CNS applied in the radical surgery of PMC canincrease the average clearance of Region Ⅵ lymph nodes.3）Whether theRegion Ⅵ lymph nodes dyed, we don’t know if Region Ⅵ lymphnodes were metastasate. The method of dye tracer of thyroid can be usedto display the lymphatic drainage, but it still cannot serve as the basis forjudging the metastasis of lymph nodes.4）Inject CNS before the radicalsurgery of PMC under ultrasound-guided ruduce the leakage rate, avoidpollution surgical field.