纳米碳示踪剂标记前哨淋巴结在结肠癌根治术中的应用

Carbon nano-particle mapping of sentinel lymph nodes in colon cancer patients undergoing radical resection

目的研究结肠癌根治术中运用纳米碳示踪剂标记结肠癌前哨淋巴结（sentinellymphnode，sLN）的可行性、准确性。方法将北京大学肿瘤医院于2009年7月至2011年3月问收治的行根治性切除的63例结肠癌患者作为实验组，于根治术中向癌周注射纳米碳注射液共1ml（50mg）进行sLN标记显像，分别记录sLN数目及未染色淋巴结数目，术后行病理学检查；选取同期行根治性切除手术中未进行纳米碳示踪剂标记的结肠癌患者90例作为对照组。应用sPsS17．0软件进行统计学分析，计量资料采用t检验，计数资料采用x检验，P〈0．05为差异有统计学意义。结果实验组63例通过注射纳米碳共检出淋巴结1640枚，平均每例26．0枚，sLN检出率100％，获取纳米碳染色淋巴结481枚，平均每例7．6枚。其中发现有淋巴结转移者3l例，共发现转移淋巴结198枚，平均每例3．1枚。其中纳米碳染色转移淋巴结34枚，黑染度为17．2％。在获取淋巴结总数和转移淋巴结数目上两组差异有统计学意义（P=0．000，P=O．001）。sLN对区域淋巴结转移状况预测的灵敏度为52％，准确性为76％。特异性为100％，假阴性率为48％。剔除实验组中23例T4期患者，40例T分期在T1～3的患者sLN对区域淋巴结转移状况预测的灵敏度为79％，准确性为90％，特异性为100％，假阴性率为21％。结论通过术中注射纳米碳标记sLN检测，能明显提高结肠癌根治术的淋巴结清扫数量，提高肿瘤淋巴结转移的检出率，提高肿瘤分期的准确性。

Objective To identify if intraoperative injecting carbon nanoparticles （CNP） is a feasible,precise and safe method of sentinel lymph node mapping （SLNM）. Methods In this study, 63 colon cancer patients from July 2009 to March 2011 were included. 1 ml （50 rag） CNP was locally injected into subserosa around the neoplasm intraoperatively. In comparison 90 colon cancer patients underwent radical resection without CNP injection （control group）. After operation both SLN and non-SLN were collected and analyzed compared with the lympbnodes collected in control group. Clinical feasibility, detection rate, and sensitivity of the method were analyzed. The categorical variables were analyzed with the Pearson Chi-square or Fisher＇s exact test, whereas the continuous variables were analyzed with t test, significance was determined as P 〈 0. 05. Results 1640 lymph nodes were detected in 63 patients（ with an average 26. 0 per case）, SLNs were identified in all cases （100%）,481 SLNs were collected （with an average 7.6）. Totally 198 metastatic lymph nodes were detected in 31 patients （ average 3.1 ） , including 34 metastatic SLNs. Total number of lymph nodes and number of metastatic lymph nodes detected in CNP group were higher than those of control group （ P = 0. 000, P = 0. 001 ）. The sensitivity, accuracy, specificity and false negative rate were 52%, 76%, 100% and 48% respectively. The sensitivity, accuracy, specificity and false negative rate were adjusted to 79% ,90% , 100% and 21% respectively if all T4 stage patients were excluded. Conclusions SLN detection can increase the number of lymph nodes harvested and improve the detection rate of lymph node metastasis.