Background

Injection of carbon nanoparticle (CN) into the thyroid gland is used to stain CLNs in endoscopic surgery of patients with papillary thyroid cancer (PTC). The black-dye technique facilitates the central lymph nodes (CLNs) harvest and parathyroid protection, but improper handling of CN during injection leads to unwanted staining of surrounding tissues and increases the difficulty in anatomical identification. Therefore, a new method is needed to overcome this problem.

Methods

Forty-eight patients with PTC underwent endoscopic thyroidectomy via breast approach. Patients were randomized into the indocyanine green (ICG) group (Group ICG; n = 23) and CN group (Group CN; n = 25). After thyroid gland exposure, ICG was injected into the thyroid lobes. Fluorescent CLNs were identified and dissected in Group ICG. In Group CN, CN was used instead. Black dyed CLNs were harvested. The following was compared between groups: demographic characteristics, surgical time, drainage amount, hospital stay duration, number of CLNs harvested, frequency of postoperative hoarseness and hypothyroidism, and surgical cost.

Results

Group ICG showed decreased hypoparathyroidism frequency than Group CN (1/23 vs. 7/25, p = 0.028) and more harvested CLNs (4.6 ± 1.0 vs. 3.8 ± 1.2, p = 0.020). There was no difference between drainage amount, hospital stay duration, and frequency of postoperative hoarseness. The cost of Group ICG was less than that of Group CN (p = 0).

Conclusion

Injection of ICG into the thyroid gland using fluorescence imaging in endoscopic surgery in patients with PTC is safer and more effective in identifying CLNs than injection with CN. This novel method can lead to improved identification and subsequent harvesting of CLNs.

中文翻译：

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吲哚菁绿和碳纳米颗粒在内镜下甲状腺乳头状癌患者中央淋巴结清扫术中的比较。

背景

在甲状腺乳头状癌（PTC）患者的内窥镜手术中，将碳纳米颗粒（CN）注射到甲状腺用于染色CLN。黑染料技术有利于中央淋巴结（CLN）的收获和甲状旁腺的保护，但是注射过程中对CN的不当处理会导致周围组织的染色，并增加解剖学鉴定的难度。因此，需要一种新的方法来克服这个问题。

方法

48例PTC患者通过乳房入路行内镜甲状腺切除术。将患者随机分为吲哚菁绿（ICG）组（ICG组；n  = 23）和CN组（CN组；n  = 25）。甲状腺暴露后，将ICG注射到甲状腺叶中。在ICG组中鉴定并解剖了荧光CLN。在CN组中，使用CN代替。收获黑色的CLN。在各组之间进行了以下比较：人口统计学特征，手术时间，引流量，住院时间，收集的CLN数量，术后声音嘶哑和甲状腺功能减退的频率以及手术费用。

结果

ICG组的甲状旁腺功能减退频率低于CN组（1/23对7/25，p  = 0.028）和更多的CLN收获（4.6±1.0对3.8±1.2，p  = 0.020）。引流量，住院时间和术后声音嘶哑的频率之间没有差异。ICG组的成本低于CN组（p  = 0）。

结论

与CN注射相比，在PTC患者的内窥镜手术中使用荧光成像将ICG注射到甲状腺中更安全，更有效地识别CLN。这种新颖的方法可以改善对CLN的识别和收获。