微粒子活性炭对腹腔镜结直肠癌手术淋巴结清扫的指引作用

Effect of activated charcoal on directing lymph node dissection in laparoscopic colorectal surgery

目的:探讨微粒子活性炭在腹腔镜结直肠癌手术中指引清除淋巴结的临床意义。方法:随机将2005年10月至2007年12月我院收治的70例结直肠癌病例分为:标记组35例,患者术前经肠镜在肿瘤周围局部注射微粒子活性炭后行腹腔镜结直肠癌根治术,对照组35例,仅行常规腹腔镜结直肠癌根治术。切除标本中的淋巴结由外科医师仔细检查剖出、计数并做病理检查。结果:腹腔镜术中被微粒子活性炭黑染的肠系膜淋巴结清晰可见;标记组平均每例清除淋巴结(27.03±2.770)枚,对照组为(15.09±1.522)枚(P<0.001);淋巴结转移病例中,标记组平均每例清除转移淋巴结(9.08±1.782)枚,对照组(5.00±1.00)枚(P<0.001);标记组平均每例清除小转移淋巴结(3.83±1.528)枚,对照组(1.62±0.961)枚(P<0.001)。结论:术前注射微粒子活性炭在腹腔镜结直肠癌手术中对淋巴结清扫有指引作用,不仅淋巴结清除总数明显增多,而且可清除更多和更小的转移淋巴结,提高了根治程度。

Objective：To evaluate the clinical significance of activated charcoal on directing lymph node dissection in laparoscopic colorectal surgery. Methods：Seventy with colorectal cancer underwent laparoscopic surgery were enrolled in the study and were randomly divided into two groups：labelling group （n = 35 ） and control group （n = 35 ）. In the labeling group all the cases were injected activated charcoal in the periphery of carcinomas by colonoscopy one to seven days before operation. All cases in the control group underwent laparoscopic eolorectal surgery without activated charcoal injection. Results：The labeled lymph nodes were easily identified during the operation. The average number of eliminated lymph nodes was （27.03 ± 2. 770 ） in the labelling group and （ 15.09 ± 1. 522 ） in control group（ P 〈 0. 001 ）. In the eases of lymph node metastasis, the average number of metastatic lymph nodes eliminated was （9.08 ± 1. 782） in the labelling group and （5.00 ± 1.00） in control group（P 〈0. 001 ）. The average number of small lymph nodes eliminated was （3.83 ± 1. 528 ） in labelling group and （ 1.62 ± 0. 961 ） in control group （ P 〈 0. 001 ）. Conclusions： The preoperative injection of actived carbon has significantly directing effect on lymph node dissection in laparoscopie colorectal surgery and can improve the degree of radical cure.