术前内镜下纳米碳标记在消化道肿瘤外科手术中的作用探讨

Discussion on the role of preoperative endoscopic nano carbon labeling in gastrointestinal cancer surgery

目的探讨术前内镜下纳米碳标记在消化道肿瘤外科手术中病灶定位、淋巴结示踪及术后淋巴结分拣的作用。方法2018年2月-2019年5月郑州大学附属肿瘤医院内镜中心对50例胃癌及44例结直肠癌患者进行术前纳米碳标记,对所选病例内镜下标记情况、外科手术术中及术后情况进行汇总分析。结果所有患者均在术前一次性完成内镜下纳米碳标记,操作时间约5.0~15.0 min,无出血、穿孔等并发症发生,标记时间距离手术开始时间3 h^5 d。38例患者行腹腔镜手术,56例患者行开腹手术,术中定位瘤体时间约0.5~2.5 min,手术时间60.0~135.0 min,手术过程中肉眼下均清晰可见纳米碳定位部位,所需清扫的区域淋巴结均存在可视及的黑染,术后标本淋巴结应用纳米碳显影联合动脉血管入路方法进行分拣,平均分拣时间15.0 min,50例胃癌患者平均分拣淋巴结数目43枚,44例结直肠癌患者平均分拣淋巴结数目29枚,均高于美国国立综合癌症网络(NCCN)指南标准。结论胃癌及结直肠癌术前内镜下纳米碳标记有助于术中对病灶的准确定位,尤其是小病灶或未侵及消化道浆膜层的病变;术前标记可使纳米碳充分扩散,有利于术中范围清扫,并使手术标本的淋巴结分拣简便快捷,获取的淋巴结数目更多,有利于病理分期和术后辅助治疗。

Objective To investigate the role of preoperative endoscopic nano-carbon labeling in the localization of the lesions,lymph node tracing and postoperative lymph node sorting in gastrointestinal cancer surgery.Methods From February 2018 to May 2019,50 cases of gastric cancer and 44 cases of colorectal cancer were treated with preoperative nano-carbon labeling and the conditions of endoscopic labeling,intraoperative and postoperative conditions of the selected cases were summarized and analyzed.Results All the patients underwent endoscopic nano-carbon labeling at one time completed before surgery.The endoscopic operation time was about 5.0~15.0 min,and no bleeding,perforation or other complications occurred.The labeling time ranged from 3 h^5 d before surgery.38 patients with laparoscopic surgery,56 patients underwent open operation,intraoperative localization tumors had time 0.5~2.5 min,operation time 60.0~135.0 min.During the operation,the positioning sites of nano-carbon were all clearly visible,required for cleaning of regional lymph nodes are very visible and in black dye.The lymph nodes of postoperative samples were collected by nano carbon imaging combined with arterial approach,the average working time about 15.0 min,50 patients with gastric cancer were sorting through lymph node number average 43,44 patients with colorectal cancer were sorting through lymph node number average 29(All above are higher than the NCCN guidelines).Conclusion The preoperative endoscopic nano-carbon labeling of gastric cancer and colorectal cancer is helpful for the accurate localization of the lesions,especially the small lesions or the lesions not invading the digestive tract serous layer.Preoperative markers can fully diffuse the carbon nanoparticles,facilitate intraoperative dissection,facilitate lymph node sorting of surgical specimens,and obtain more lymph nodes,which is conducive to pathological staging and postoperative adjuvant treatment.