纳米碳淋巴示踪剂在乙状结肠癌及高位直肠癌腹腔镜根治术中的应用

Application of lymph node labeling with carbon nanoparticles in laparoscopic radical resection for sigmoid and upper rectal cancer

目的:探讨纳米碳淋巴示踪剂在乙状结肠癌及高位直肠癌腹腔镜根治术中的临床应用价值。方法:回顾分析2010年5月至2016年12月为153例乙状结肠癌及高位直肠癌患者行腹腔镜根治术的临床资料,59例患者术前1 d肠镜下于肿瘤周围注射纳米碳(观察组),94例患者直接手术(对照组);分析比较两组大体标本情况及淋巴结检出情况。结果:与对照组相比,观察组标本长度较短[(17.8±5.3)cm vs.(19.7±4.2)cm,P=0.020],近切缘距肿瘤距离较短[(7.3±3.7)cm vs.(8.6±3.3)cm,P=0.028)],远切缘距肿瘤距离较短[(4.7±1.8)cm vs.(5.7±2.6)cm,P=0.014)],淋巴结检出数量较多[(16.9±6.5)vs.(11.2±5.9),P<0.001],淋巴结<12枚比例较低(13.6%vs.59.6%,P<0.001)。结论:腹腔镜乙状结肠癌及高位直肠癌腹腔镜根治术中应用纳米碳淋巴示踪技术有助于指导合理选择手术切除范围,提高淋巴结检出率,具有较高的临床应用价值。

Objective： To investigate the value of lymph node labeling with carbon nanoparticles in laparoscopic radical resection for sigmoid and upper rectal cancer. Methods： From May 2010 to Dec. 2016,the clinical data of 153 patients who underwent laparoscopic radical resection for sigmoid and upper rectal cancer were retrospectively analyzed. Among them,59 patients（ the observation group） were injected with carbon nanoparticles into the periphery of the tumor under colonoscopy on the first day before the operation,while 94 patients（ the control group） received operation directly. The conditions of the gross specimen and the number of the harvested lymph nodes were compared between the two groups. Results： Compared with the control group,the mean length of the gross specimen was significantly shorter [（ 17. 8 ± 5. 3） cm vs.（ 19. 7 ± 4. 2） cm,P = 0. 020],the mean distance from superior margin to tumor was significantly shorter [（ 7. 3 ± 3. 7） vs.（ 8. 6 ± 3. 3） cm,P = 0. 028],the mean distance from inferior margin to tumor was significantly shorter [（ 4. 7 ± 1. 8） cm vs.（ 5. 7 ± 2. 6）,P = 0. 014],the mean number of the harvested lymph nodes was significantly more [（ 16. 9± 6. 5） vs.（ 11. 2 ± 5. 9）,P〈0. 001 ],and the rate of less than 12 harvested lymph nodes was significantly fewer（ 13. 6% vs.59. 6%,P〈0. 001） in the observation group. Conclusions： Application of lymph node labeling with carbon nanoparticles in laparoscopic radical resection of sigmoid and upper rectal cancer contributes to confirming the reasonable excision extension,improving the lymph node detection rate,and is of high clinical application value.