纳米炭在腔镜直肠癌根治术淋巴结示踪、定位、清扫和转移中的应用

The Application of Nano-carbon in Lymph Node Tracing,Location,Dissection and Metastasis in Endoscopic Radical Resection of Rectal Cancer

目的:探讨纳米炭示踪剂在腹腔镜直肠癌根治术淋巴结的示踪、定位、清扫和转移中的应用。方法:选取2017年9月-2020年7月荆州市第一人民医院胃肠外科收治的71例直肠癌患者,随机分为实验组(纳米炭组)37例和对照组34例。术后记录实验组、对照组检出所有淋巴结直径、数量、直径≤5 mm的淋巴结数量及阳性淋巴结数量。将实验组所有淋巴结分别进行常规HE染色及CK20免疫组化,对CK20免疫组化与HE染色检出淋巴结转移进行分析。结果:两组均顺利完成手术,实验组(760枚)与对照组(459枚)检获的总淋巴结数量差异有统计学意义(P<0.05)。实验组所有患者淋巴结总数均大于12枚,而对照组有8例小于12枚,差异有统计学意义(P<0.05)。实验组(460枚)与对照组(197枚)在术中检获直径≤5 mm的微小淋巴结数量差异有统计学意义(P<0.05)。两组患者常规病理HE染色检出的淋巴结转移数目及术后病理分期的比较差异无统计学意义(P>0.05)。实验组760枚淋巴结中,常规HE染色(43枚)与CK20免疫组化(64枚)在检测淋巴结转移方面比较差异有统计学意义(P<0.05),CK20与HE染色对直肠癌Ⅲ期患者诊断率差异无统计学意义(P>0.05)。结论:将纳米炭示踪剂运用于腹腔镜直肠癌根治术中,能有效定位肿瘤,术中指导医师进行淋巴结清扫,提高淋巴结清扫数量,增加微小淋巴结(直径≤5 mm)检出的数量;术后使用CK20免疫组化可以提高淋巴结微小转移灶的检出,有助于提高术后病理分期的准确性及制订患者术后的个体化辅助治疗。

Objective To explore the application of nano-carbon tracer in the tracing,positioning,dissection and metastasis of lymph nodes in laparoscopic radical rectal cancer surgery.Methods A total of 71 patients with rectal cancer were randomly divided into an experimental group(nano-carbon group)of 37 cases and a control group of 34 cases treated in the Gastrointestinal Surgery Department of Jingzhou First People's Hospital from September 2017 to July 2020.After the operation,the diameter and number of all detected lymph nodes and the number of lymph nodes with a diameter of≤5 mm were recorded in the experimental group and control group.The lymph nodes of the experimental group are subjected to conventional HE staining and CK20 immunohistochemistry respectively,and the results of their diagnosis of lymph node metastasis rate are analyzed.Results Both groups successfully completed the operation,and there was a statistically significant difference in the number of total lymph nodes in the experimental group(760 pieces)and the control group(459 pieces)(P<0.05).The total number of lymph nodes in all patients in the experimental group was greater than 12,while in the control group,there were 8 patients with less than 12 lymph nodes,and the difference was statistically significant(P<0.05).The experimental group(460 pieces)and the control group(197 pieces)had a statistically significant difference in the number of small lymph nodes with a diameter of≤5 mm during the operation(P<0.05).There was no significant difference in the number of lymph node metastases detected by conventional pathological HE staining and postoperative pathological staging between the two groups(P>0.05).Among the 760 lymph nodes in the experimental group,43 were positive for conventional HE staining,and 64 were positive for CK20 immunohistochemistry.There was a statistically difference in the detection rate of lymph node metastasis(P<0.05).CK20 immunohistochemistry and HE staining showed no difference in the diagnosis rate of patients with stageⅢrectal cancer(P>0.05).Conclusion The application of nano-carbon tracer in laparoscopic radical rectal cancer surgery can guide physicians to perform lymph node dissection,increase the number of lymph node dissection,and increase the number of small lymph nodes(diameter≤5 mm)detected.The postoperative CK20 immunohistochemistry can improve the detection of micrometastases in lymph nodes,improve the accuracy of postoperative pathological staging and formulate postoperative individualized adjuvant therapy.