手助腹腔镜胃癌淋巴结清扫规范性的临床研究

Standardization of lymph node dissection in hand-assisted laparoscopic radical gastrectomy for stomach cancer

目的:应用纳米碳微粒作为淋巴结示踪剂,评价手助腹腔镜胃癌根治术中淋巴结清扫的规范性。方法:回顾性分析8个月内实施手助腹腔镜胃癌根治术患者40例的临床资料。将手术中注射纳米碳混悬液后进行淋巴结清扫的患者15例设为观察组,其余25例为对照组。结果:观察组15例中,小弯侧淋巴结显色12例(80.00%);8a组和6组淋巴结色染各8例(53.33%);脾门和大弯侧淋巴结色染各3例(20.00%)。观察组与对照组的主要手术相关指标,包括切口长度[(6.90±0.28)cm vs.(6.82±0.38)cm],术中出血量[(286±168)mL vs.(235±98)mL],手术时间[(182±31)min vs.(176±21)min],淋巴结检出数[(16.8±6.71)枚vs.(14.9±3.90)枚],术后住院时间[(10.1±3.8)d vs.(11.6±6.5)d],差异均无统计学意义(均P>0.05)。结论:淋巴结示踪剂的应用,对完善术中淋巴结清扫有一定的辅助作用;更能体现出手助腹腔镜胃癌根治术淋巴结清扫的规范性。

Objective： To assess the standardization of lymphadenectomy in hand-assisted laparoscopic radical gastrectomy for stomach cancer using nanocarbon particles as lymph node （LN） tracer. Methods： The clinical data of 40 patients with gastric cancer undergoing hand-assisted laparoscopic surgery for radical gastrectomy within a period of 8 months were retrospectively analyzed. Of the patients, 15 cases who received intraoperative nanocarbon suspension injection before LN clearance were designated as observation group, and another 25 cases served as control group. Results： Of the 15 patients in observation group, the LNs along the lesser curvature of the stomach were labeled in 12 cases （80.00%）, No.8a or No.6 LNs staining were found in 8 cases each （S3.33%）, and the LNs staining were found in 3 cases each （20.00%） in the splenic hilum or greater curvature of the stomach. All the main surgical indexes that included the incision length [（6.90±0.28） cm vs. （6.82±0.38） cm], intraoperative blood loss [（286±168） mL vs. （235±98） mL], operative time [（182±31） min vs. （176±21） mini, number of lymph nodes detected （16.8±6.71 vs. 14.9±3.90）, and length of postoperative hospital stay [（10.1±3.8） d vs. （11.6±6.5） d], between the observation group and control group showed no statistical differences （all P〉0.05）. Conclusion： The application of LN tracer has certain adjunctive effects for improving the LN dissection during surgery. The use of tracer in hand-assisted laparoscopic radical gastrectomy can better reflect the standardization of LN dissection.