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目的比较纳米炭和亚甲蓝在高分化性甲状腺肿瘤并行甲状腺腺叶切除术的患者中对甲状旁腺功能的保护性作用。方法将96例高分化性甲状腺肿瘤行甲状腺切除术患者采用抽签法随机分为3组即纳米炭组、亚甲蓝组及对照组,每组各32例。其中纳米炭组和亚甲蓝组,于手术中在甲状腺内分别注射纳米炭和亚甲蓝,再行甲状腺腺叶切除术;对照组于甲状腺内注射等量的生理盐水,再行甲状腺腺叶切除术。观察记录上述两种示踪剂的起始示踪时间及示踪持续时间,检测术后24 h及1个月患者血钙及甲状旁腺素(PTH)水平。术后3个月内保持随访,比较以上3组患者甲状旁腺功能的恢复情况。结果纳米炭组的示踪起始时间更短[(16.9±2.8)s],示踪持续时间更长(>1 200 min)。术后24 h及1个月纳米炭组出现一过性低血钙、PTH暂时性减退、永久性低血钙及PTH永久性减退共4例,远低于亚甲蓝组(8例)及对照组(17例),组间比较差异具有统计学意义(P<0.05)。且术后3个月随访显示,纳米炭组的甲状旁腺功能恢复时间远短于亚甲蓝组及对照组,差异具有统计学意义(P<0.05)。结论纳米炭较亚甲蓝对在甲状腺术中的甲状旁腺功能的保护性更好,值得临床广泛使用。
Objective To compare the protective effects of nanocarbons and methylene blue on parathyroid function in patients with well-differentiated thyroid tumors and thyroid lobectomy. Methods Ninety-six patients with well-differentiated thyroid tumors underwent thyroidectomy were randomized into three groups, namely carbon nanocarbon group, methylene blue group and control group, with 32 cases in each group. Among them, the nanocarbon group and the methylene blue group were respectively injected with nanocarbon and methylene blue in the thyroid during operation, and thyroidectomy was performed again. In the control group, the same amount of normal saline was injected into the thyroid gland, and then the thyroid gland cut. The initial tracing time and tracing duration were recorded and recorded. The level of serum calcium and parathyroid hormone (PTH) was measured at 24 h and 1 month after operation. Follow-up was performed within 3 months after operation, and the recovery of parathyroid function in the above three groups was compared. Results The tracing time was shorter (> 16.9 ± 2.8 s) in the nanocarbon group and the tracing time was longer (> 1 200 min). There were 4 cases of transient hypocalcemia, permanent hypothyroidism, permanent hypocalcemia and permanent reduction of PTH in the nanocarbon group at 24 h and 1 month after operation, which were much lower than those in the methylene blue group (n = 8) The control group (17 cases), the difference between the groups was statistically significant (P <0.05). The 3-month follow-up showed that the recovery time of parathyroid function in the carbon nanocarbon group was much shorter than that in the methylene blue group and the control group, with statistical significance (P <0.05). Conclusion Nanocarbons are more effective than methylene blue in protecting thyroid function during thyroid surgery, which is worth to be widely used clinically.