纳米炭淋巴示踪技术在胆囊癌手术中的应用

Clinical application of carbon nanoparticles lymphatic tracer technology to guide surgery for gallbladder cancer

目的探讨纳米炭淋巴示踪剂（CH40）在胆囊癌手术中的应用价值。方法将120例胆囊癌患者随机分为实验组（60例）和对照组（60例）。实验组于术中在胆囊壁浆膜下4—6点注射纳米炭注射液，每点0．1ml。术中参考黑染的淋巴结适当调整淋巴清扫范围，解剖标本，取出淋巴结并依据淋巴结位置分组，送病理检查。对照组常规行胆囊癌根治术。结果标本中可见实验组淋巴结有广泛的黑染，实验组平均每例检获的淋巴结数[（12．0±3．8）个]、阳性淋巴结数[（6．3±3．3）个]等均显著高于对照组[（9．2±3．6、4．4±2．8）个，P〈0．05]；术后无瘤生存时间[（27．3±1．4）月]、生存时间[（45．7±2．3）月]较对照组长[（19．6±1．3月、37．0±2．4）月，P〈0．05]，两组差异有统计学意义。结论术中应用纳米炭注射液能明显提高淋巴结检获的数量，最大可能地清除转移的淋巴结，指导病理分期，提高患者术后无瘤生存时间和总体生存时间。

Objective To study carbon nanoparticles lymphatic tracer to guide surgery for gallbladder cancer. Methods 120 patients with gallbladder cancer were randomized into two groups： the experimental group （ n = 60） and the control group （ n = 60）. For the experimental group, 0.1 ml carbon nanoparticles was injected at 4 - 6 locations subserosally around the cancerous site intraoperatively. Stained lymph nodes were used as markers to guide lymphadenectomy. The resected specimens were carefully dissected, and then the lymph nodes were studied according to their positions by histopathological examinations. Resuits Various degrees of stained lymph nodes were seen in the specimens. In the experimental group, the number of lymph nodes （ 12.0 ±3.8）, and metastatic lymph nodes （6.3 ±3.3） per patient were obviously higher than those in the control group （9.2 ±3.6,4.4 ± 2.8） , respectively, （ P 〈 0.05 ）. There were significant differences （P 〈 0.05 ） in postoperative disease-free survival and overall survival. Conclusions Intraoperative injection of carbon nanoparticles enhanced lymph node clearance and increased the number of lymph nodes and metastatic lymph nodes dissected, which helped to guide pathological staging. There were significant improvements in disease-free survival and overall survival of these patients with gallbladder cancer after surgery.