纳米碳染色标记在内镜下切除早期结肠癌后追加外科手术中的病灶定位作用

Effect of nano carbon tattooing on the lesion localization in the early colon cancer for additional surgical procedure after endoscopic resection

目的 探讨纳米碳染色标记在早期结肠癌经内镜下切除治疗后追加外科手术时的病灶定位作用。 方法 2014年5月至2016年11月，解放军福州总医院对35例经内镜下切除治疗的早期结肠癌患者追加了外科手术。所有病例在内镜下切除治疗结束前进行纳米碳染色标记：于肠镜下在距病灶边缘1 cm处上、下、左、右4个位点的正常肠壁黏膜下层各注射纳米碳混悬液0.1 ml，以此标记病灶原始位置，进而指导后续追加外科手术时的病灶定位。对这组病例资料进行总结。结果 35例患者中，男22例，女13例，年龄35~70（46.5 ± 11.0）岁，均在肠镜下一次性完成纳米碳标记，操作时间5~10（7.5 ± 2.5）min，无出血和穿孔并发症发生，无不良反应。内镜下切除治疗后4~21（10.0 ± 3.5）d，内镜下切除标本病理示10例脉管侵袭阳性、7例黏膜下层高度浸润、7例癌瘤出芽分级G2以上、6例低分化腺癌或未分化癌、5例切缘阳性而追加外科手术。本组均行腹腔镜手术，术中探查定位病灶时间1~5（3.0 ± 1.5）min，肉眼下清晰可见纳米碳染色部位，实施结肠楔形切除术5例、结肠肠段切除术14例、结肠癌根治术16例。手术时间45~180（120 ± 30）min，术中出血20~150（50 ± 15）ml，无术中并发症。术后首次肛门排气时间12~48（24 ± 8）h，术后住院时间3~10（6.5 ± 2.5）d，无术后并发症，无围手术期死亡。结论 纳米碳染色标记有助于早期结肠癌内镜下切除治疗后追加外科手术中对原始病灶的准确定位，提高外科手术尤其是腹腔镜手术的安全性和精准性。

Objective To explore the effect of nano carbon tattooing on the lesion localization in the early colon cancer for additional surgical procedure after endoscopic resection. Methods Thirty-five patients with early colon cancer accepted additional surgical procedures after endoscopic resection in Fuzhou General Hospital of PLA from May 2014 to November 2016. All the patients underwent nano carbon tattooing before the end of endoscopic resection： 0.1 ml carbon nanoparticles suspension was respectively injected into the normal intestinal submucosa from 1 cm outside the 4 sites （upper, lower, left and right） of the lesion border by colonoscopy, marking the original lesion location and guiding the subsequent additional surgery. Data of these 35 cases were summarized. Results All the 35 cases, including 22 males and 13 females, with a mean age of 46.5 years （range 35-70） , completed the endoscopic disposable carbon nano marking, and the mean operative time was 7.5 minutes （range 5-10） . No bleeding, no perforation and no adverse reaction occurred. Four to 21 （10 ± 3.5） days after endoscopic resection, the patients received the additional surgery as a result of pathological specimens of endoscopic resection in 10 cases of vascular invasion, 7 cases of severe submucosal infiltration, 7 cases of more than grade G2 in tumor budding, 6 cases of poorly differentiated adenocarcinoma and undifferentiated carcinoma, and 5 cases of positive margin. All the patients underwent laparoscopic surgery. The mean time of intraoperative detection and lesion location was 3.0 minutes （range 1-5） . All tattooings were clearly visible under the naked eye. The colon wedge resection were performed in 5 cases, colon segment resection in 14 cases, and radical resection of colon cancer in 16 cases. The operative time was 45 to 180 （120 ± 30） min, and the blood loss was 50~200 （50 ± 15） ml. There was no intraoperative complications. The first gas passage time was 12 to 48 （24 ± 8） h. The postoperative hospital stay was 10 to 3 （6.5 ± 2.5） d. There was no postoperative complication and no perioperative mortality. Conclusion Nano carbon tattooing is helpful for the accurate location of primary lesions in the additional surgical operation after endoscopic resection of early colon cancer, and it can improve the safety and precision of surgical procedures, especially for laparoscopic surgery.