直肠癌周围黏膜下注射微粒子碳在TME术中的应用

Clinical application of submucosal injection of particulate carbon around the rectal cancer lesions in total mesorectal excision

目的:探讨微粒子碳在直肠癌全直肠系膜切除术(TME)中的应用价值.方法:对45例直肠癌患者术前3d在直肠镜癌周黏膜下注射微粒子碳,行全直肠系膜切除术.并与常规TME手术组进行比较.所有切除淋巴结行RT-PCR法检测MMP-7mRNA的表达以确定此淋巴结有无转移.结果:实验组共清除淋巴结1056枚,平均23.5枚.对照组清除淋巴结723枚,平均16.1枚,两组比较有统计学意义(t=7.3733,P<0.05).实验组清除转移淋巴结403枚,平均9.0枚.对照组281枚,平均6.2枚,差别具有统计学意义(t=5.4235,P<0.05).实验组黑染淋巴结共680枚,其中转移淋巴结322枚,两者具有线性相关关系(r=0.3468,P<0.05).结论:黏膜下注射微粒子碳应用于直肠癌TME术可增加术中转移淋巴结的清除.直肠癌淋巴结墨染与转移有关.

AIM： To evaluate the application value of particulate carbon in total mesorectal excision.. METHODS： Particulate carbon was submucosally injected around the rectal cancer lesions under rectoscope in 45 patients 3 d before total mesorectal excision. The expression of matrix metaUoproteinase-7 （MMP-7） mRNA was detected by reverse transcription-polymerase chain reaction （RT-PCR） to ascertain the lymph node metastasis. RESULTS： The labelled lymph nodes were easily identified during the operation. The average numbers of eliminated lymph nodes and metastatic lymph nodes in the labelled group were larger than those in the controls （23.5 vs 16.1, t = 7.3733, P 〈 0.05; 9.0 vs 6.2, t = 5.4235, P 〈 0.05）. In the labelled group, there were 680 labelled lymph nodes, of which 322 were metastatic ones. The numbers of labelled and metastatic lymph nodes were linearly correlated with each other （r = 0.3468, P 〈 0.05）. CONCLUSION： Submucosal injection of particulate carbon can help to clean metastatic lymph nodes in total mesorectal excision. The number of labelled lymph nodes is correlated with that of metastatic lymph nodes.