内镜纳米炭标记对直肠癌新辅助放化疗疗效判断及手术的价值

Clinical value of carbon nanoparticles marker for neoadjuvant chemoradiotherapy of rectal cancer

目的探讨局部进展期直肠癌新辅助放化疗前行内镜注射纳米炭标记对疗效判断及后续治疗的临床价值。方法前瞻性纳入2015年7月至2015年12月在福州总医院治疗的局部进展期直肠癌患者18例，其中男11例、女7例，年龄35～68岁，平均（45．8±12．5）岁。患者在新辅助放化疗前均接受内镜下标记，黏膜下注射生理盐水后，于肿瘤病灶肛侧距肿瘤边缘1cm处前、后、左、右4个象限正常肠壁黏膜下层多点注射纳米炭混悬液（5mg/处）进行标记；标记后经新辅助放化疗＋休息时间共5～11周，平均（8±2）周后，再行外科手术。观察内镜纳米炭标记在判断患者新辅助放化疗前后肿瘤大小、肿瘤下缘距肛缘距离、术中情况及手术保肛率等变化的效果。结果内镜纳米炭标记操作时间5～15min，平均（10．0±3．5）min，未见不良反应，未发生出血、穿孔等并发症。新辅助放化疗后肿瘤全部缩小，其中完全消失7例，占38．9％；病理完全缓解6例，占33．3％；肿瘤下缘距肛缘距离为4．5～10．0cm，平均（6．4±1．8）cm。术中肠管外可见100％病灶黑染，位置清晰，部分区域淋巴结黑染；行保肛手术8例，手术保肛率44．4％。结论局部进展期直肠癌患者新辅助放化疗前行内镜注射纳米炭标记既可更好地判断新辅助放化疗的疗效，又有助于手术精准定位，示踪淋巴结，且染色效果持久，有利于后续外科手术或随访观察。

Objective To explore the clinical value of carbon nanoparticles marker before neoadjuvant chemoradiotherapy （NACRT） of locally advanced rectal cancer. Methods Clinical data of 18 patients （ 11 male and 7 temale） with locally advanced rectal cancer admitted to Fuzhou General Hospital from July 2015 to December 2015 was analyzed retrospectively. Patients were 45.8±12.5 （35-68） yearsold. Before NACRT, carbon nanoparticles were injected through an endoscope. The multiple-point injection was I cm from the lesion （4 quadrants of the upper, lower, left and right） to avoid direct injection into the tumor. The injection suspension of carbon nanoparticles was 5 mg per point. Alter endoscopic marking, the duration of NACRT plus rest was 8±2 （5-11） weeks, and then the surgery was performed. Effects of endoseopic carbon nanoparticles markers on judgment of the tumor size, the distance from the lower margin of the tumor to the anal border, the intraoperative condition and the rate of anus preservation were observed. Results The operation time was 10.0±3.5 （5-15）min. No adverse reactions, and bleeding,perforation or other complications occurred. After NACRT, all tumors were reduced, completely disappeared in 7 eases （38.9%） , and pathologically respond in 6 cases （33.3%）. The distance between the lower margin of the tumor and the margin of the anal border was 6.4±1.8 （4.5-10.0）cm. In the operation, 100% lesions were found to be stained black outside the intestine, with clear location and partial lymph node dysphasia. Eight cases received anus preserving operation, and the rate of anus preservation was 44.4%. Conclusion The carbon nanoparticles marker can accurately position the tumor and label the lymph node for locally advanced rectal cancer before NACRT. The dyeing effect is lasting, conducive to the surgery or follow-up observation.