纳米炭在腹腔镜下食管胃交界腺癌手术中的应用

Application of Nano-Carbon Particles in Laparoscopic Operation for Adenocarcinoma of Esophagogastric Junction

目的探讨腹腔镜下食管胃交界腺癌手术中使用纳米炭淋巴示踪剂引导手术清扫淋巴结的可行性和临床效果。方法回顾性分析2008～2011年期间我院行腹腔镜下食管胃交界腺癌手术119例患者的临床资料,征得患者知情同意后应用改制的注射针在腹腔镜下于肿瘤周围浆膜下注射纳米炭后行腹腔镜辅助近侧胃切除56例(研究组),未行纳米炭示踪注射行腹腔镜辅助近侧胃切除63例(对照组),比较2组患者的清扫淋巴结枚数、转移淋巴结枚数以及手术指标(手术时间、术中出血量)和术后住院时间。结果 2组患者均顺利完成手术,研究组术前在肿瘤周围浆膜下纳米炭注射均成功。结果显示,研究组淋巴结检出枚数及转移淋巴结枚数均明显多于对照组〔检出淋巴结(:20.52±4.51)枚比(16.44±3.80)枚,t=5.341,P=0.000;转移淋巴结:(8.88±3.15)枚比(6.49±2.49)枚,t=4.602,P=0.000〕;研究组的术中出血量、手术时间及术后住院时间与对照组比较,差异均无统计学意义〔术中出血量(:97.50±27.52)ml比(96.03±22.83)ml,t=0.318,P=0.751;手术时间(:221.07±24.25)min比(230.48±38.54)min,t=-1.570,P=0.119;术后住院时间(10.82±1.67)d比(10.29±1.33)d,t=1.945,P=0.054〕。结论在腹腔镜下食管胃交界腺癌手中应用纳米炭淋巴示踪剂,操作简单、易行,能增加术后淋巴结的送检数目,不增加术中出血量、手术时间和术后住院时间。

Objective To explore the feasibility and clinical effect of the nano-carbon particles in laparoscopic operation for adenocarcinoma of esophagogastric junction. Methods From 2008 to 2011, 119 patients with adenocarcinoma of esophagogastric junction who underwent the laparoscopic operation were divided into study group （n=56） and control group （n：63）. The nano-carbon particle was injected into the subserosa around the tumor using the injection needle made by ourselves for lymphatic tracing before the laparoscopic operation in the study group, while no tracer was given in the control group. The indexes of lymph nodes, operation time, intraoperative blood loss, and postoperative hospital stay were compared in two groups. Results The nano-carbon particle was injected into the subserosa around the tumor successfully in the study group. The numbers of dissected lymph nodes and metastatic lymph nodes in the study group were significantly more than those in the control group （dissected lymph nodes： 20. 52±4. 51 versus 16. 44±3.80, t=5. 341, P=-0. 000; metastatic lymph nodes： 8.88±3.15 versus 6. 49±2. 49, t=4. 602,P=0. 000）. There were no statistical differences in the intraoperative blood loss, operation time, and postoperative hospital stay in two groups 0ntraoperative blood loss： （97.50±27. 52） ml versus （96. 03±22. 83） ml, t=0. 318, P=0. 751; operation time：（221.07±24. 25） min versus （230. 48±38.54） min, t=-l. 570, P=-0. 119; postoperative hospital stay （10. 82±1.67） d versus （10. 29±1.33） d, t= 1. 945, P=0. 054]. Conclusions Injection of the nano-carbon particles using the injection needle made by ourselves is feasible in laparoscopic operation for adenocarcinoma of esophagogastric junction. It can increase number of dissected lymph nodes without increasing operation time, intraoperative blood loss, and postoperative hospital stay.