纳米碳示踪技术在根治性顺行模块化胰体尾切除术中治疗胰体尾部恶性肿瘤中的应用价值

Application value of nano-carbon tracer technique in the treatment of malignant tumors of pancreatic body and tail in radical antegrade modular pancreatosplenectomy

目的通过将纳米碳示踪技术应用在根治性顺行模块化胰体尾切除术(RAMPS)中,治疗胰体尾部恶性肿瘤,探讨RAMPS联合纳米碳示踪技术是否更有利于患者预后。方法回顾性分析2014年1月-2018年9月临沂市中心医院收治的48例患者,均行RAMPS,术后均病理证实为胰体尾部恶性肿瘤。根据术中是否行纳米碳淋巴结示踪法,将患者分为纳米碳组(术中行纳米碳淋巴结示踪法)23例和常规手术组(术中未行纳米碳淋巴结示踪法)25例。分析两组患者的手术时间、术中出血量、术后并发症(胰瘘)、术后住院时间、术后病理淋巴结情况(清扫个数、淋巴结阳性数目、纳米碳组淋巴结黑染阳性率)及术后生存期等情况。计量资料以均数±标准差(Mean±SD)表示,组间比较采用t检验;计数资料组间比较采用x^2检验;生存率比较采用Kaplan-Meier检验。结果两组患者的手术时间[(4.45±0.59)h比(4.41±0.65)h]、术中出血量[(447.39±109.51)ml比(434.8±76.38)ml]及术后住院时间[(16.52±4.12)d比(16.56±2.92)d]等情况差异均元统计学意义(P>0.05)。纳米碳组患者出现1例胰瘘,常规手术组患者出现2例胰瘘,但差异无统计学意义(P=0.55)。纳米碳组患者清扫淋巴结个数[(18.26±2.49)枚]及淋巴结阳性数目[(5.52±1.50)枚]明显高于常规手术组清扫淋巴结个数[(12.16±2.19)枚]及淋巴结阳性数目[(3.32±0.85)枚],差异均具有统计学意义(P<0.05);黑染淋巴结中淋巴结阳性率(38.10%,96/252)明显高于未黑染淋巴结中淋巴结阳性率(18.45%,31/168),差异具有统计学意义(P<0.05);纳米碳组患者术后平均生存期[(25.48±11.74)个月]明显多于常规手术组[(15.80±11.64)个月],差异具有统计学意义(P<0.05)。结论RAMPS联合纳米碳示踪技术治疗胰体尾部恶性肿瘤是安全、有效、可行的,能够提高阳性淋巴结清扫率及总淋巴结数检出率,改善患者预后,提高患者术后生存期。

Objective The application of nano-carbon tracer technique in radical antegrade modular pancreatosplenectomy (RAMPS)to treat malignant tumors of pancreatic body and tail.To investigate whether radical anterograde modulization of pancreatic body and tail combined with nano-carbon tracer technique is more beneficial to the prognosis of patients.Methods From January 2014 to September 2018,a retrospective analysis was performed in 48 patients in Linyi Central Hospital,all patients underwent RAMPS,all of whom were pathologically proved to be pancreatic carcinoma of the body and tail.Based on whether the nano-carbon lymph node tracer was performed during the operation,the patients were divided into two groups:nano-carbon group (nanocarbon lymph node tracing)and conventional operation group (no nano-carbon lymph node tracer).The differences between the two groups were analyzed,including operative time,intraoperative blood loss,postoperative complications (pancreatic fistula),postoperative hospitalization time,postoperative pathological lymph node status (number of dissection,number of positive lymph nodes,the positive rate of lymph node black staining in nanocarbon group)and survival time after operation.The measurement data were expressed as mean ±standard deviation (Mean±SD),t-test were used for comparison among groups;Chi-square test was used for comparison of counting data,and Kaplan-Meier test was used for comparison of survival rate.Results There was no significant difference in the time of operation [(4.45 ±0.59)h vs (4.41±0.65 )h],the amount of blood lost during operation [(447.39±109.51)ml vs (434.8±76.38)ml]and the time of hospitalization after operation [(16.52 ±4.12)d vs (16.56±2.92)d]between the two groups (P>0.05).There were 1 case of pancreatic fistula in the nano-carbon group and 2 cases of pancreatic fistula in the convertional operation group,but the difference was not statistically significant (P =0.55 ).The number of lymph nodes dissected and positive lymph nodes in nano-carbon group were significantly higher than those in conventional operation group [(18.26±2.49)vs (12.16±2.19);(5.52±1.50)vs (3.32±0.85).The difference was statistically significant (P <0.05 ).The positive rate of lymph nodes in black stained lymph nodes (38.10%,96/252)was significantly higher than that in non-stained lymph nodes (18.45%,31/168),and the difference was statistically significant (P <0.05 ).The average survival time in the nano-carbon group [(25.48 ±11.74)months]was significantly longer than that in the conventional operation group [(15.80±11.64 )months],and the difference was statistically significant (P <0.05 ). Conclusions It is safe,effective and feasible to treat malignant tumors of pancreatic body and tail by RAMPS combined with nano-carbon tracer technique.The positive rate of lymph node dissection and the detection rate of total lymph nodes are increased,and the prognosis of patients is improved,to improve the survival time of patients after operation is improved.