微粒子活性炭-丝裂霉素(CH-MMC)在直肠癌根治术中的导向性研究

Directing effect of CH-MMC in standard lymphadenectomy for rectal cancer

目的探讨微粒子活性炭-丝裂霉素(CH-MMC)在直肠癌根治性手术中的应用。方法选取直肠癌患者60例,随机分为两组:标记组34例,术前1-7 d通过纤维结肠镜在肿瘤附近正常肠管黏膜下多点注射CH-MMC;对照组26例,未注射CH-MMC。所有患者均行直肠癌根治性手术,术中常规清除各站淋巴结。比较两组病理标本所检出的淋巴结数量。结果标记组平均清除淋巴结(18.41±2.45)枚,明显高于对照组(15.12±1.47)枚(P<0.01)。标记组平均清扫≤5 mm淋巴结数目(12.65±1.63)枚,明显高于对照组(6.03±1.22)枚(P<0.01)。标记组19例淋巴结转移患者中平均清扫转移淋巴结(10.03±1.59)枚,明显高于对照组12例淋巴结转移患者中平均清扫转移淋巴结(5.93±1.06)枚。标记组黑染淋巴结中发生转移率高于未黑染淋巴结中的转移率(40.22%vs 19.77%,P<0.01)。结论术前多点注射微粒子活性炭-丝裂霉素(CH-MMC)在直肠癌手术中有一定的导向作用,提高了区域淋巴结的清除及检出率。

Objective To evaluate the clinical significance of activated carbon particle delivery system-MMC （CH-MMC） in radical operation for rectal cancer. Methods Sixty patients with rectal cancer were randomized into two groups ：labeling group （ n = 34） and control group（n = 26）. All cases in labeling group were injected with CH-MMC in the periphery of carcinoma by colonoscopy at day 1 - 7 before radical operation for rectal cancer. All cases in control group underwent radical operation for rectal cancer without CH-MMC injection. The numbers of lymph nodes detected in pathological samples were compared between two groups. Results The average number of dissected lymph nodes was higher in labeling group than that in control group （ 18.41± 2.45 vs 15.12 ± 1.47, P 〈 0.01 ）. The average number of small lymph nodes（ ≤5 mm） was higher in labeling group than that in control group（ 12.65 ± 1.63 vs 6.03± 1.22 ,P 〈0.01 ）. The number of dissected lymph nodes in metastatic patients was higher in labeling group than that in patients without lymph node metastasis （ 10.03 ± 1.59 vs 5.93 ± 1.06）. The positive rate of lymph node was higher in black-stained lymph nodes than that in unstained lymph nodes（40.22% vs 19.77% ,P 〈 0.01 ）. Conclusion The preoperative injection of CH-MMC has a signifi- cant directing effect on lymph node dissection in radical operation of rectal cancer and can increase the rate of dissected lymph nodes.