| Background and purposeThyroid cancer is one of the most common endocrine tumors in China.80%-85% of them are papillary thyroid carcinoma(PTC),which mainly endangers children and young women.Although cervical lymph node metastasis(LNM)occurs early in PTC,it has a high degree of differentiation,and most patients have a good prognosis.Surgery is the best choice for PTC treatment.Sometimes,it is difficult to distinguish the lymph nodes from the fat granules or parathyroid gland(PTG)when clearing the lymph nodes around the tumors.The blind pursuit of complete lymph node clearance is likely to result in parathyroid dysfunction.Nano carbon tracing technology can solve this problem.It specifically darkens the thyroid gland and surrounding lymph nodes,and parathyroid gland is colorless,which is helpful to protect parathyroid gland during operation.At present,nano carbon has been widely used in clinical surgery,but there are few reports about its use in endoscopic thyroidectomy(ET).The purpose of this study is to explore and study the effect of nano carbon in ET,so as to provide theoretical basis for the application of nano carbon in ET.MethodFrom October 2017 to September 2019,60 cases of PTC in general surgery of our hospital were collected.30 cases in the experimental group were labeled with nano carbon and 30 cases in the control group were not treated with nano carbon.Patients in both groups underwent endoscopic total thyroidectomy and contralateral subtotal adenoidectomy after general anesthesia.Meanwhile,the lymph nodes in the central area of the affected side were also removed.Patients were followed up for 3 to 6 months after surgery.The number of central lymph nodes removed,the number of PTG exposure and miscutting,and the number of cases of hypoparathyroidism were recorded in the two groups.Finally,the two groups of data were analyzed for statistical significance.ResultThere was no significant difference in age,sex,tumor stage,serum calcium and PTH between the two groups(P>0.05).In the experimental group,160 lymph nodes were removed,with an average of 5.33±1.32.In the control group,116 lymph nodes were removed,with an average of 3.87±1.04.The data of the two groups were compared,P<0.05,the difference between the two groups was statistically significant.A total of 29 positive lymph nodes were cleared in the experimental group and 27 in the control group.There was no significant difference between the two groups(P>0.05).There were 47 PTG exposed in the experimental group,with an average of1.57±0.50,and 34 PTG exposed in the control group,with an average of 1.13±0.51.The data of the two groups were compared,P<0.05,there was statistical difference between the two groups.One case in the experimental group showed that part of PTG tissue was excised,and two cases in the control group showed that part of PTG tissue was excised.The incidence of hypoparathyroidism in the experimental group was less than that in the control group.The data of the two groups were compared,P<0.05,there was statistical difference between the two groups.The staining of nano carbon was helpful for the operator to distinguish RLN and SLN,but there was no significant difference in the number of RLN and SLN injury between the two groups(P > 0.05).There was no significant difference between the two groups in operation time,bleeding volume and postoperative hospital stay(P > 0.05).ConclusionNano carbon in ET can help the operator to distinguish PTG,lymph nodes and fat particles.It can help the operator to increase the number of lymph nodes removed and the number of PTG exposed,so as to reduce the function damage of PTG.It can also help the operator to distinguish RLN and SLN,but have no significant influence on the operation time,blood loss and postoperative hospital stay. |
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