纳米碳显影联合动脉血管入路法在直肠癌淋巴结分检中的技术优势分析

Technical advantages of nano carbon development combined with artery approach in lymph node sorting of rectal cancer

目的 探讨纳米碳显影联合动脉血管入路法在直肠癌淋巴结分检中的技术优势。方法 2015年12月至2016年6月，河南省肿瘤医院普通外科70例直肠癌患者随机分为纳米碳显影联合动脉血管入路组（动脉血管入路组）和传统方法组。动脉血管入路组将手术标本置于分检台上，自肠系膜下动脉根部开始解剖左结肠动脉、乙状结肠动脉和直肠上动脉，沿着动脉血管走形仔细查找黑染淋巴结和未被染色的淋巴结（可能呈粉红色、淡黄色、乳白色或淡褐色等），采用视觉和触觉相结合的方法辨认淋巴结。自肠系膜下动脉根部分检中央组淋巴结，沿血管走形分检血管旁淋巴结，在直肠周围寻找肠旁淋巴结。正面寻找结束后将标本反转在背面进行淋巴结分检。传统方法组按常规方法分检淋巴结，对照两组检出淋巴结总数、平均检出淋巴结数、阳性淋巴结数和淋巴结〈12枚患者数等指标。结果 70例直肠癌患者中，男性37例，女性33例，中位年龄57（32~88）岁；行直肠癌前切除（Dixon）46例，行腹会阴联合直肠癌根治术（Miles）24例。全组共分检出淋巴结1 105枚，其中动脉血管入路组641枚，传统方法组464枚，差异有统计学意义（t= 20.717，P= 0.000）。动脉血管入路组淋巴结分检时间（12.6 ± 3.9）min，少于传统方法组的（18.2 ± 4.1）min（t= 12.464，P= 0.000）。动脉血管入路组直径〈 5 mm淋巴结共142枚，分检率22.2%（142/641），其中29枚为阳性（20.4%）；传统方法组直径〈 5 mm淋巴结共37枚，分检率8.0%（37/464），其中6枚为阳性（16.2%）。动脉血管入路组和传统方法组第1站淋巴结总数分别为282枚（44.0%）和169枚（36.4%），第2站淋巴结总数分别为230枚（35.9%）和180枚（38.8%），第3站淋巴结总数分别为129枚（20.1%）和115枚（24.8%）。结论 采用纳米碳显影联合动脉血管入路方法在直肠癌淋巴结分检中具有操作简便，获取淋巴结数目多，更有利于准确病理分期等优点。

Objective To explore the technical advantages of nano carbon development combined with artery approach in lymph node sorting of rectal cancer.Methods From December 2015 to June 2016, 70 patients with of rectal cancer in General Surgery Department of Henan Cancer Hospital were randomly divided into nano carbon development combined with artery approach group （artery approach group） and conventional group. Specimen of artery approach group was placed on the sorting table. Anatomy was performed from the root of inferior mesenteric artery to left colonic artery, sigmoid artery and superior rectal artery. Along the arterial vessel shape, the black-stained lymph nodes and non-stained lymph nodes （perhaps pink, pale yellow, white or pale brown） were examined carefully using visual and haptic combination method for identification of lymph node. From the root of inferior mesenteric artery, central lymph nodes were sorted. Along the vessel shape, vascular lymph nodes were sorted. Intestinal lymph nodes around the rectum were examined as well. Then, specimen was reversed on the sorting table and underwent sorting as above after the examination of obverse. The conventional group received routine method. The total number, the average harvested number, the number of positive lymph nodes and the number of patients with lymph nodes less than 12 were compared between two groups.Results Among 70 cases, 37 were male and 33 were female with the median age of 57 （32-88） years old. Dixon resection was performed in 46 cases, and Miles resection in 24 cases. Total sorting lymph node was 1 105, including 641 of artery approach group and 464 of control group with significant difference （t= 20.717, P= 0.000） . Lymph node sorting time of artery approach group was （12.6 ± 3.9） minutes, which was shorter than （18.2 ± 4.1） minutes of control group （t= 12.464, P= 0.000） . In artery approach group, number of lymph node with diameter less than 5 mm was 142, sorting rate was 22.2% （142/641） , of which 29 were positive （20.4%） . In conventional group, 37 lymph nodes with diameter less than 5 mm were found, and sorting rate was 8.0% （37/464） , of which 6 were positive （16.2%） . Number of the first station of lymph node sorting in artery approach group and conventional group was 282 （44%） and 169 （36.4%） ; number of the second station lymph node sorting was 230 （35.9%） and 180 （38.8%） ; number of the third station lymph node sorting was 129 （20.1%） and 115 （24.8%） .Conclusion The method of nano carbon development combined with artery approach in lymph node sorting of rectal cancer has some advantages, such as simple operation, more harvested lymph nodes, and more accurate pathological staging.