纳米碳淋巴结示踪剂在结直肠癌根治术中的应用

Application of carbon nanoparticles mapping lymph nodes in curative resection for colorectal carcinoma

目的:探讨术前行肠镜纳米碳淋巴结示踪法在结直肠癌根治术中的应用价值。方法:采用病例对照研究方法,回顾性收集2016年3月至2018年3月期间,中山大学附属第六医院收治的、术前明确为结直肠癌、接受结直肠癌根治术并有完整术后病理资料的患者,排除术前诊断为肠梗阻、急诊手术及肿瘤复发再次手术者,共1 421例结直肠患者符合纳入排除标准,其中术前通过肠镜行纳米碳示踪156例,未行纳米碳示踪1 265例。病例对照匹配按照1∶3根据患者性别、体质量、肿瘤T分期和TNM分期以及术前化疗等方面进行匹配,最终纳入纳米碳示踪组145例,对照组435例。纳米碳示踪组患者于术前2.4(1.0~14.0)d行肠镜检查,在距离肿瘤边缘约0.5~1.0 cm处黏膜下,注射纳米碳混悬液,采用4点注射法,分别在0点、3点、6点、9点方向注射0.25 ml。比较两组淋巴结检出总数、阳性淋巴结检出数及淋巴结阳性率,并分析不同T分期、N分期、TNM分期、是否新辅助化疗等亚组中,两组淋巴结检出情况。结果:病例对照匹配后,纳米碳示踪组淋巴结检出总数高于对照组[(22.2±11.2)枚比(19.0±9.5)枚, t=3.025, P=0.003],差异有统计学意义。两组间淋巴结阳性数和淋巴结阳性率的差异无统计学意义(均 P>0.05)。亚组分析显示,纳米碳示踪组的淋巴结检出总数在T 3期(中位数:22枚比18枚, Z=2.435, P=0.015)、N 0期(中位数:20.5枚比17.5枚, Z=2.772, P=0.006]、TNM分期Ⅱ期(中位数:23.5枚比19.0枚, Z=2.654, P=0.008)和术前化疗人群中(中位数:22.5枚比13.0枚, Z=3.287, P=0.001),均高于对照组;但纳米碳示踪组N 2期阳性淋巴结数(中位数:4.0枚比6.5枚, Z=-2.530, P=0.011)和淋巴结转移度(中位数:16%比31%, Z=-2.862, P=0.004)均低于对照组,差异均有统计学意义。 结论:纳米碳淋巴示踪技术能有效提高结直肠癌根治手术淋巴结检出数。

Objective To investigate the clinical application of carbon nanoparticles mapping lymph nodes in curative resection for colorectal carcinoma.Methods Patients diagnosed with colorectal cancer before operation and undergoing radical surgery with intact postoperative pathological data in the Sixth Affiliated Hospital,Sun Yat-sen University from March 2016 to March 2018 were included in this retrospective case-control study.Those who were diagnosed with ileus,recurrent carcinoma or underwent emergency operation were excluded.A total of 1421 cases were included,with 156 cases in the carbon nanoparticles mapping group and 1265 cases in the control group.Using 1∶3 case control matching based on gender,weight,TNM staging and neoadjuvant chemotherapy,145 and 435 cases were finally recruited in the carbon nanoparticles mapping group and control group,respectively.Patients in the carbon nanoparticles mapping group underwent preoperative colonoscopy with carbon nanoparticles submucosal injection 2.4(1.0-14.0)days before operation.Carbon nanoparticles of 0.25 ml was injected at 4 points(3,6,9 and 12 o'clock each)0.5-1.0 cm around the tumor.The number of eliminated lymph node,number of positive lymph node and positive rate between the two groups were compared,and the number of eliminated lymph node in different subgroups of T stage,N stage,TNM stage and neoadjuvant chemotherapy was analyzed and compared.Results After case control matching,total number of eliminated lymph nodes in the carbon nanoparticles mapping group was significantly higher than that in the control group(22.2±11.2 vs.19.0±9.5,t=3.025,P=0.003).However,no statistically significant differences were found in the number of positive lymph node and lymph node positive rate between two groups(all P>0.05).Subgroup analysis showed that as compared to the control group,total number of eliminated lymph nodes in the carbon nanoparticles mapping group was significantly higher in T3 stage subgroup(median:22 vs.18,Z=2.435,P=0.015),N0 stage subgroup(median:20.5 vs.17.5,Z=2.772,P=0.006),TNM II stage subgroup(median:23.5 vs.19.0,Z=2.654,P=0.008)and neoadjuvant chemotherapy(median:22.5 vs.13.0,Z=3.287,P=0.001),while compared to the control group,the number of positive lymph node(median:4.0 vs.6.5,Z=-2.530,P=0.011)and the lymph node metastasis degree(median:16%vs.31%,Z=-2.862,P=0.004)were lower in the carbon nanoparticles mapping group in N2 subgroup.Conclusion Carbon nanoparticles mapping lymph nodes can effectively enhance the number of eliminated lymph nodes in curative resection for colorectal cancer.