纳米炭示踪技术在腹腔镜进展期胃癌根治术中的临床应用

Clinical Study on Carbon Nanoparticles Tracer Technique Guided Laparoscopic Radical Resection of Advanced Gastric Cancer

目的探讨纳米炭示踪技术应用于腹腔镜下进展期胃癌根治术淋巴结清扫的临床价值。方法回顾分析我科2014年1月-2015年6月186例胃癌的临床资料,选择成功完成腹腔镜下远端胃癌D2根治术60例,其中纳米炭示踪剂30例为实验组,未用纳米炭示踪剂30例为对照组。实验组在手术过程中应用纳米炭混悬注射液（卡纳琳）,对照组不给予任何药剂注射。比较2组标本离体后检获淋巴结数目和转移率。结果实验组清扫淋巴结（38.9±7.4）枚,明显多于对照组（28.7±6.1）枚（t=5.826,P=0.000）,其中清扫直径≤2 mm淋巴结（8.3±3.9）枚,明显多于对照组（5.8±3.3）枚（t=2.680,P=0.010）;实验组转移淋巴结（10.4±3.6）枚,明显多于对照组（5.6±2.8）枚（t=5.765,P=0.000）。实验组黑染淋巴结数目632枚,黑染率54.1%（632/1168）,黑染淋巴结转移率23.3%（147/632）,明显高于对照组淋巴结转移率14.4%（124/860,χ^2=19.155,P=0.000）和未黑染淋巴结转移率12.3%（66/536,χ^2=23.305,P=0.000）。结论纳米炭淋巴示踪剂应用于进展期胃癌淋巴结清扫可清扫较多的淋巴结,提高小淋巴结及阳性淋巴结的清扫率。

Objective To explore the clinical value of carbon nanoparticles tracer technique guided laparoscopic radical resection of advanced gastric cancer. Methods A retrospective analysis was made on clinical data of 180 cases of gastric cancer treated from January 2014 to June 2015. We selected 60 cases who were successfully performed laparoscopic D2 radical gastrectomy,including 30 cases receiving nanocarbon tracer as the experimental group and 30 cases without nanocarbon tracer as the control group.The experimental group was given carbon nanoparticles suspension injection（ Canari） during the operation,whereas the control group did not receive any drug injection. The number and diameter of lymph nodes were detected after the sample was isolated. The rate of black stain and metastasis rate of lymph nodes were compared statistically. Results In the experimental group,the total number of lymph node dissection was significantly more than that in the control group[（ 38. 9 ± 7. 4） vs.（ 28. 7 ± 6. 1）,t = 5. 826,P = 0. 000],and the number of lymph nodes whose diameter were less than 2 mm was significantly more than that in the control group [（ 8. 3 ± 3. 9）vs.（ 5. 8 ± 3. 3）,t = 2. 680,P = 0. 010]. The number of lymph node metastasis was 10. 4 ± 3. 6 in the experimental group,which was significantly higher than that in the control group（ 5. 6 ± 2. 8,t = 5. 765,P = 0. 000）. The experimental group had a number of black stained lymph node of 632,with a staining rate of 54. 1%（ 632 /1168） and a black stained lymph node metastasis rate of 23. 3%（ 147 /632）,which were significantly higher than the control group with respect to the metastasis rate [14. 4%（ 124 /860）,χ^2=19. 155,P = 0. 000] and non-stained lymph node metastasis rate [12. 3%（ 66 /536）,χ^2= 23. 305,P = 0. 000]. Conclusion Application of carbon nanoparticles tracer technique in laparoscopic radical resection of advanced gastric cancer can obtain more lymph nodes dissected,with improved rates of small lymph node and positive lymph node dissection.