纳米炭在腹腔镜中低位直肠癌根治术中的应用价值

Applied value of lymph tracing material carbon nanoparticles in laparoscope midst-low position rectal cancer radical operation

目的探讨淋巴示踪剂纳米炭颗粒在腹腔镜中低位直肠癌根治术中的应用价值。方法将30例中低位直肠癌随机分成纳米炭组和对照组。前者在术前经肛于癌灶周围黏膜下注射纳米炭，然后行腹腔镜直肠癌根治术，后者常规行腹腔镜直肠癌根治术。观察前者术中侧方淋巴示踪情况，比较两组在手术时间、清扫淋巴结数目、转移淋巴结数目、术后病理分期上的差异。结果纳米炭组共检出277枚淋巴结，对照组检出淋巴结218枚，纳米炭组检出淋巴结均数较对照组多（18．47±4．53比15．07±2．19），且差异有统计学意义（P〈0．05）。两组在淋巴结转移率上（纳米炭组60／277、21．66％比对照组15／218、6．88％）差异有统计学意义（P〈0．01）。在术后病理分期上的差异有统计学意义（P〈0．05）。纳米炭组有3例术中可见侧方髂内血管旁淋巴结黑染，行黑染淋巴结切除活检快速冰冻检查，1例结果为癌疑，随对该例加行侧方淋巴结清扫，术后病理证实为淋巴结转移。结论纳米炭对于指导腹腔镜直肠癌根治术术中的选择性侧方淋巴结清扫具有潜在价值；纳米碳的应用能够增加术后转移淋巴结的检出，精确术后病理分期。

Objective To evaluate the value of lymph tracing material carbon nanoparticles （CNP） in laparoscopic radical operation for patients with mid-low rectal cancer. Methods Thirty patients with extraperitoneal rectal cancer were randomized into two groups ： CNP group and control group. The former were injected with CNP through anus under the mucous membrane around lesion before the laparoscopic rectal cancer radical operation, and the latter underwent the laparoscopic rectal cancer radical operation according to the concention. The state of the lateral pelvic lymph tracing was observed. Operative time, the number of harvested lymph nodes, the number of metastatic lymph nodes and pathological stages between two groups were compared. Results 277 lymph nodes were harvested in the CNP group,while 218 lymph nodes in the control group. The mean of harvested lymph nodes in the CNP group was more than that in the control group （ P 〈 0.05 ）. There was significant difference in the metastatic rate of lymph nodes （CNP group 60/277,21.66% vs control group 15/218,6.88%, P 〈 0.05 ）, and the pathological stages （ P 〈 0.05 ） between two groups. In 3 cases of the CNP group, the lateral lymph nodes were dyed black, and resected. One case was suspected of carcinoma and received the dissection of the lateral lymph nodes, and the pathological examination after operation confirmed the lymph nodes metastasis. Conclusion CNP may have potential value in the selective dissection of lateral lymph nodes in patients with midst-low rectal cancer, and also can increase the detection rate of metastastic lymph nodes, which can make the pathological statges after operation more accurate.