纳米炭联合钛夹标记对于远端胃癌腹腔镜手术的应用价值

Application of carbon nanoparticles combined with titanium clip tattooing in laparoscopic surgery of distal gastric cancer

目的探讨内镜下纳米炭联合钛夹标记对远端胃癌腹腔镜手术的定位作用。方法收集2018年1月至2019年12月于第九〇〇医院经内镜及病理初次确诊的胃癌患者共69例,随机分为纳米炭联合钛夹标记组和非标记组。所有患者均行腹腔镜手术,标记组于术前1周内行内镜下纳米炭联合钛夹标记,然后行腹部平片,以此标记病灶原始位置,进而指导后续腹腔镜手术时对于病灶的定位及切除。比较两组术中出血量、术中探查病灶时间、总手术时间、首次切缘阳性率、近端切缘距病灶长度。结果69例患者中,其中标记组36例,非标记组33例,均在胃镜下一次性完成纳米炭及钛夹标记,标记过程中无出血和穿孔并发症发生,无不良反应。标记组术中均清晰可见纳米炭标记点,术中探查病灶时间标记组短于非标记组[(10.20±1.94)min vs(25.08±10.49)min,P<0.001],总手术时间标记组短于非标记组[(182.25±52.97)min vs(229.68±55.00)min,P=0.001],术中出血量标记组少于非标记组[(109.27±30.62)ml vs(124.93±31.76)min,P=0.041],近端切缘距病灶长度标记组短于非标记组[(3.01±0.92)cm vs(4.30±1.66)cm,P<0.001],首次切缘阳性率标记组低于非标记组(0 vs 6.06%,P=0.225)。所有患者均无术中及术后并发症,无围手术期死亡。结论内镜下纳米炭联合钛夹标记用于远端胃癌定位安全可靠,有助于外科手术中对原始病灶的准确定位并进行精准切除,可明显缩短总手术时间及减少手术带来的创伤,提高远端胃癌腹腔镜手术中的精准性和安全性,值得临床推广。

Objective To investigate the effect of carbon nanoparticles combined with titanium clip tattooing on the lesion localization in laparoscopic surgery of distal gastric cancer.Methods Sixty-nine patients diagnosed with gastric cancer in 900th Hospital of the Joint Logistics Support Force of PLA from Jan.2018 to Dec.2019 were randomly divided into tattooing group and non-tattooing group.All patients underwent laparoscopic surgery.The tattooing group underwent carbon nanoparticles combined with titanium clip tattooing before the laparoscopic surgery,then took a abdominal plain film to marking the original lesion location and guiding the subsequent additional surgery.The following parameters were compared:identifyication time,operation time,blood loss and distance from lesion to operation proximal margin;the rate of first positive resection margin.Results Sixty-nine patients were involved in this study,including 36 cases in tattooing group and 33 cases in non-tattooing group.No bleeding,no perforation and no adverse reaction occurred when tattooed.All carbon nanoparticles tattooings were clearly visible under the naked eye.Significant differences favoring tatooing were found with regard to identification time[(10.20±1.94)min vs(25.08±10.49)min,P<0.001],operation time[(182.25±52.97)min vs(229.68±55.00)min,P=0.001],blood loss[(109.27±30.62)ml vs(124.93±31.76)min,P=0.041],distance from lesion to operation proximal margin[(3.01±0.92)cm vs(4.30±1.66)cm,P<0.001].The rate of first positive resection margin in tattooing group was lower than that in non-tattooing group(0 vs 6.06%),while there was no statistical difference between two groups(P=0.225).There were no postoperative complications and no perioperative mortality.Conclusion Carbon nanoparticles combined with titanium clip tattooing is helpful for the accurate location in laparoscopic surgery of distal gastric cancer,and it can improve the safety and precision of surgical procedures.