术中纳米碳示踪显示中枢淋巴系统的临床研究

Intraoperative exploration of central lymphatic system using carbon nanoparticles suspension： A clinical study

目的 探讨术中纳米碳示踪显示中枢淋巴系统构成的可行性.方法 回顾性纳入2016年12月至2017年7月滨州医学院附属医院神经外科收治的7例脑膜瘤患者.术中通过局部肿瘤表面硬膜下点状注射纳米碳混悬液,观察纳米碳引流及扩散方式,采集影像学图像并进行硬脑膜病理学检查.结果 7例患者中,5例硬膜下存在不同程度的纳米碳引流,其中3例出现了向矢状窦引流的现象,1例向颅底方向引流,另外1例出现肿瘤下方正常脑组织引流静脉周围黑染并向矢状窦方向引流;另2例未发现明显的引流管道.对局部黑染的硬脑膜行HE染色,可见黑染通道周围为缺乏细胞结构的条索样裂隙,内有少量的有核细胞,但未见明显的类似内皮细胞排列.纳米碳聚集严重部位周围可见大量类似肥大细胞的有核细胞聚集.结论 术中纳米碳示踪显示中枢淋巴系统构成是可行的,中枢淋巴系统与各种病理生理机制的关系研究具有极其重要意义,值得进一步探索.

Objective To study the feasibility of using carbon nanoparticles to intraoperatively explore the central lymphatic system.Methods Between December 2016 and July 2017,a series of 7 patients with meningiomas were admitted to Neurosurgery Department at Binzhou Medical University Hospital and enrolled into this retrospective study.Subdural injection of carbon nanoparticles suspension （CNPS） was performed over the tumor area during operation.We observed the epidural dyeing and diffusion of CNPS,collected the images and conducted meningeal pathology examination.Results Among 7 cases,5 cases demonstrated varying extent of CNPS drainage including 3 with drainage into the sagittal sinus,1 with drainage to cranial base and 1 with drainage into the sagittal sinus and venous dyeing below the tumor entity.HE staining indicated that there was an obvious potential lacuna beside the dyed channel which had little nucleated cells and lacked endothelial cells.There were abundant mast cell-like nucleated cells around the area with dense dyeing of CNPS.Conclusion It appears to be feasible to use CNPS to explore the central lymphatic system,which is closely related to various pathophysiological mechanisms and worth further investigating.