胃癌病灶周围注射超微活性炭对淋巴结的显色效果

Effect of injecting activated carbon ultramicroparticles around the gastric tumor on staining lymph node

目的观察胃癌病灶周围注射超微活性炭后局部淋巴结的黑染效果,指导胃癌手术淋巴结的清扫。方法43例胃癌患者术前或术中肿瘤周围注射超微活性炭,82例胃癌未接受注射者作为对照组,比较其清扫淋巴结的数目、黑染淋巴结数、淋巴结黑染与注射活性炭时间的关系、淋巴结转移情况,并观察副作用的发生。结果活性炭组每例患者清扫的淋巴结数(34枚±13枚)明显高于对照组(16枚±9枚),主要是清扫的N2淋巴结数明显最多(25枚±9枚∶8枚±4枚);活性炭组黑染度为603%,N1淋巴结的黑染度(713%)高于N2(563%);局部组织内注射超微活性炭,2d后淋巴结的黑染效果才较满意;黑染淋巴结中发生淋巴结转移的阳性率(268%)明显高于未黑染淋巴结(33%)及对照组(184%);局部组织注射超微活性炭未见严重副作用发生。结论肿瘤周围局部注射超微活性炭是一种有效、易行和安全的方法,对胃癌淋巴结清扫有指导作用。

Objective To observe the effect of injecting activated carbon ultramicroparticles around the gastric tumor before or during operation on staining lymph nodes and guiding the lymphadenectomy of gastric cancer Methods Forty three cases of gastric cancer received activated carbon (AC) ultramicroparticles around the tumor by submucosal endoscopic injection 1～6 days before the operation and/or intraoperative subserosal injection (AC group), whereas 82 cases of gastric cancer without the injection were used as control group The number of dissected lymph nodes, number of black stained lymph nodes and its relation to the injection time, metastasis of lymph nodes, and the side effect of the procedure were analyzed Results The average numbers of resected lymph nodes were 34±13 in the AC group, significantly higher than that in the control group (16±9, P <0 05) The dissected N 2 lymph nodes in the AC group was 25±9, significantly higher than that in the control group (8±4, P <0 05) The total ratio of black stained lymph node was 60 3% in general, 71 3% for the N1 lymph nodes and 56 3% for the N 2 lymph nodes in the AC group Satisfactory effect of black staining of lymph nodes could be seen 2 days after local gastric tissue injection of activated carbon ultramicroparticles The metastasis rate was 67 4% in the AC group, not significantly different from that in the control group (63 4%, P >0 05) In the patients of AC group the metastasis rate of black stained lymph node was 26 8%, significantly higher than that of the unstained lymph nodes (3 3%) and higher than that of the control group (18 4%) No serious side effect happened after the activated carbon ultramicroparticles injection in local gastric tissue Conclusion Local injection of activated carbon ultramicroparticles around the tumor is an effective, easy and safe procedure to guide gastric cancer lymphadenectomy