纳米炭标记对于早期胃癌内镜治疗后追加手术的应用

Effect of nano carbon tattooing on the lesion localization in the gastric cancer for additional surgical procedure after endoscopic resection

[目的]拟探讨内镜下纳米炭标记对早期胃癌经内镜切除治疗后追加外科手术的定位作用。[方法]入选经内镜切除治疗的早期胃癌追加外科手术患者共27例。所有病例在内镜切除术后追加外科手术前进行内镜下纳米炭标记,以此标记病灶原始位置,进而指导后续追加外科手术时的病灶定位。对病例资料进行总结。[结果]27例均在胃镜下一次性完成纳米炭标记,标记过程中无出血和穿孔并发症发生,无不良反应。内镜下切除治疗后3~7 d,切除标本病理示15例黏膜下层高度浸润、9例脉管侵袭阳性、3例底切缘阳性。27例均行追加腹腔镜手术,术中均清晰可见纳米炭标记点,行胃大部切除者18例,全胃切除术者9例。术中探查病灶时间1.9~5.4(3.4±1.1)min,总手术时间144.0~277.6(202.2±33.49)min,术中出血量33.4~140.4(85.7±27.3)ml,近端切缘距病灶距离1.4~5.5(3.3±1.3)cm,27例中均无一例有术中及术后并发症、无围手术期死亡。[结论]内镜下纳米炭标记用于胃肿瘤定位安全可靠,有助于早期胃癌内镜下切除治疗后追加外科手术中对原始病灶的准确定位,可提高外科手术尤其是腹腔镜手术的安全性和精准性。

[Objective]To explore the effect of carbon nanoparticles tattooing on the lesion localization in the early gastric cancer for additional surgical procedure after endoscopic resection.[Methods]Twenty-seven patients with early gastric cancer accepted additional surgical procedures after endoscopic resection in 900 Hospital of the Joint Logistics Team from July 2015 to June 2019 were involved.All the patients underwent carbon nanoparticles tattooing before the end of endoscopic resection,marking the original lesion location and guiding the subsequent additional surgery.The following parameters were collected:identification time,operation time and blood loss.[Results]All the 27 cases,including 17 males and 10 females,with a mean age of 63.7 years(range 41-76).No bleeding,no perforation and no adverse reaction occurred when tattooed.3-7 days after endoscopic resection,the patients received the additional surgery as a result of pathological specimens of endoscopic resection in 15 cases of severe submucosal infiltration,9 cases of vascular invasion,and 3 cases of positive margin.All the patients underwent laparoscopic surgery.All tattooings were clearly visible under the naked eye.The subtotal gastrectomy was performed in 18 cases and whole gastrectomy was performed in 9 cases.The mean time of identification time was 1.9-5.4(3.4±1.1)min,operation time was 144.0-277.6(202.2±33.49)min,blood loss was 33.4-140.4(85.7±27.3)ml.The proximal margin length was 1.4-5.5(3.3±1.3)cm.There was no postoperative complications and no perioperative mortality.[Conclusion]Carbon nanoparticles tattooing is helpful for the accurate location of primary lesions in the additional surgical operation after endoscopic resection of early gastric cancer,and it can improve the safety and precision of surgical procedures,especially for laparoscopic surgery.