纳米碳示踪剂在Siewert Ⅱ型和Ⅲ型食管胃结合部腺癌淋巴结清扫中的应用价值

Application value of carbon nanoparticle tracer in lymph node dissection for Siewert type Ⅱ and Ⅲ adenocarcinoma of esophagogastric junction

目的探讨纳米碳示踪剂在Siewert Ⅱ型和Ⅲ型食管胃结合部腺癌(AEG)淋巴结清扫中的应用价值。方法采用回顾性队列研究方法。收集2015年6月至2020年7月胜利油田中心医院收治的147例Siewert Ⅱ型和Ⅲ型AEG患者的临床病理资料;男109例,女38例;年龄为(65±9)岁。患者均行经腹部食管裂孔腹腔镜辅助AEG根治术。147例患者中,61例术前未注射纳米碳示踪剂,设为对照组;86例术前注射纳米碳示踪剂,设为试验组。观察指标:(1)手术及术后情况。(2)第10组淋巴结转移影响因素分析。正态分布的计量资料以■±s表示,组间比较采用t检验。计数资料以绝对数或百分比表示,组间比较采用χ^(2)检验。单因素分析根据资料类型选择对应的统计学方法,多因素分析采用Logistic逐步回归模型。结果(1)手术及术后情况。两组患者均顺利完成经腹部食管裂孔腹腔镜辅助AEG根治术。两组患者手术时间、术中出血量、淋巴结清扫总数目、第1站淋巴结清扫数目、第2站淋巴结清扫数目、阳性淋巴结数目比较,差异均无统计学意义(P>0.05)。试验组患者淋巴结黑染率为57.937%(1365/2356),第1站淋巴结、第2站淋巴结黑染率分别为77.989%(1024/1313)、43.691%(232/531),Siewert Ⅱ型和Ⅲ型AEG患者淋巴结黑染率分别为56.855%(423/744)和58.437%(942/1612)。147例患者淋巴结转移率为19.091%(815/4269),Siewert Ⅱ型和Ⅲ型AEG患者淋巴结转移率分别为18.573%(242/1303)和19.319%(573/2966);Siewert Ⅱ型AEG患者第1、2、3、4sa/4sb、7、8a、11p组淋巴结转移率均>10%,第4d、5、6、9、10、11d、12a组及下纵隔淋巴结转移率均<10%;Siewert Ⅲ型AEG患者第1、2、3、4sa/4sb、7、8a、10、11p组及下纵隔淋巴结转移率均>10%,第4d、5、6、9、11d、12a组淋巴结转移率均<10%。两组患者术后并发症Clavien⁃Dindo分级比较,差异无统计学意义(P>0.05)。(2)第10组淋巴结转移影响因素分析。多因素分析结果显示:肿瘤T分期、肿瘤分化程度是第10组淋巴结转移的独立影响因素(P<0.05)。结论Siewert Ⅱ型和Ⅲ型AEG患者术前应用纳米碳示踪剂不增加淋巴结清扫数目,Siewert Ⅲ型AEG应注重第2站淋巴结清扫。肿瘤T分期、肿瘤分化程度是第10组淋巴结转移的独立影响因素。

Objective To investigate the application value of carbon nanoparticle tracer in lymph node dissection for Siewert type Ⅱ and Ⅲ adenocarcinoma of esophagogastric junction(AEG).Methods The retrospective cohort study was conducted.The clinicopathological data of 147 patients with Siewert type Ⅱ and Ⅲ AEG who were admitted to Shengli Petroleum Central Hospital from June 2015 to July 2020 were collected.There were 109 males and 38 females,aged(65±9)years.All the patients underwent laparoscopic-assisted radical resection of AEG via esophageal hiatus.Of 147 patients,61 cases not injected with carbon nanoparticle tracer preoperatively were allocated into control group and 86 cases injected with carbon nanoparticle tracer preoperatively were allocated into experimental group.Observation indicators:(1)surgical and postoperative situations;(2)influencing factors analysis of No.10 lymph nodes metastasis.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was conducted using the t test.Count data were represented as absolute numbers or percentages,and comparison between groups was analyzed by the chi-square test.Univariate analysis was conducted by statistic methods based on data type,and multivariate analysis was conducted by the Logistic step-wise regression model.Results(1)Surgical and postoperative situations.Patients of the experimental group and control group completed laparoscopic-assisted radical resection of AEG via esophageal hiatus successfully.There was no significant difference in the operation time,volume of intraoperative blood loss,the total number of lymph node dissection,the number of the first station,the second station and positive lymph nodes between the two groups(P>0.05).For the experimental group,the black staining rate of lymph nodes was 57.937%(1365/2356),the black staining rate of the first station and second station lymph nodes was 77.989%(1024/1313)and 43.691%(232/531),the black staining rate of Siewert type Ⅱ and Ⅲ AEG patients was 56.855%(423/744)and 58.437%(942/1612),respectively.The lymph node metastasis rate was 19.091%(815/4269)of 147 patients,18.573%(242/1303)of Siewert type Ⅱ AEG patients and 19.319%(573/2966)of Siewert type Ⅲ AEG patients.For Siewert type Ⅱ AEG patients,the metastasis rate of No.1,2,3,4sa,4sb,7,8a,11p lymph nodes was more than 10%,the metastasis rate of No.4d,5,6,9,10,11d,12a lymph nodes was lower than 10%.For Siewert type Ⅲ AEG patients,the metastasis rate of No.1,2,3,4sa,4sb,7,8a,10,11p and lower mediastinal lymph nodes was more than 10%,the metastasis rate of No.4d,5,6,911d,12a and lower mediastinal lymph nodes was lower than 10%.There was no significant difference in the Clavien Dindo classification of postoperative complications between the two groups(P>0.05).(2)Influencing factors analysis of No.10 lymph nodes metastasis.Results of multivariate analysis showed that tumor T staging and degree of tumor differention was an independent influencing factor for No.10 lymph nodes metastasis(P<0.05).Conclusions For Siewert type Ⅱ and Ⅲ AEG patients,the application of carbon nano-partide tracer can not increase the number of lymph node dissection.The second station lymph node dissection should be paid attention for Siewert type Ⅱ AEG.Tumor T staging and degree of tumor differentiation are independent influencing factors for No.10 lymph nodes metastasis.