吲哚菁绿与纳米炭淋巴结示踪技术在腹腔镜右半结肠癌根治术中的应用

Indocyanine green and nanocarbon lymph node tracing in laparoscopic radical resection for right colon cancer

目的对比吲哚菁绿(indocyanine green,ICG)与纳米炭在腹腔镜右半结肠癌根治术中淋巴结示踪效果的差异。方法纳入自2020年10月至2022年7月北京大学国际医院胃肠外科收治的52例择期接受腹腔镜右半结肠癌根治术患者,随机分为ICG组和纳米炭组,每组26例,术中进行淋巴结示踪,对常规病理检测阴性淋巴结进行微转移灶检测。结果ICG组前哨淋巴结(SLN)的检出率为100%,灵敏度为93%,假阴性率为7%,准确度为96%,均优于纳米炭组(92%、57%、43%、77%)。ICG组比纳米炭组检出更多的SLN[(3.2±0.7)枚比(2.6±1.1)枚,t=4.424,P=0.020],其中阳性淋巴结数差异有统计学意义[(1.2±1.2)枚比(0.5±0.8)枚,t=15.176,P=0.013]。ICG组中BMI≥24 kg/m^(2)和肿瘤直径≥3 cm患者的SLN活检准确度明显优于纳米炭组(90%比44%,χ^(2)=7.935,P=0.005;90%比57%,χ^(2)=4.309,P=0.038),差异有统计学意义。ICG组与纳米炭组的SLN中微转移灶检出率差异有统计学意义(35%比15%,χ^(2)=5.853,P=0.016)。结论在腹腔镜右半结肠癌根治术中,ICG淋巴结示踪技术的SLN活检效率优于纳米炭,特别是对BMI≥24 kg/m^(2)和肿瘤直径≥3 cm的患者。

Objective To compare the lymph node tracing of indocyanine green(ICG)and nanocarbon in laparoscopic right hemicolectomy.Methods Fifty-two patients with right colon cancer were randomly divided into two groups:ICG group and nanocarbon group at Peking University International Hospital between Oct 2020 and Jul 2022.Sentinel lymph node(SLN)mapping and standard oncologic resection was performed.The micrometastasis was to detect when the routine SLN pathological test was negative.Results In ICG group,the detection rate of SLN was 100%,the sensitivity was 93%,the false negative rate was 7%,and the accuracy was 96%,which were better than nanocarbon group(92%,57%,43%,77%).The number of SLN and positive SLN detected in ICG group were significantly higher than nanocarbon group[(3.2±0.7)vs.(2.6±1.1),t=4.424,P=0.020;(1.2±1.2)vs.(0.5±0.8),t=15.176,P=0.013].The SLN biopsy accuracy of patients with BMI≥24 kg/m^(2) and tumor diameter≥3 cm in ICG group was significantly higher than nanocarbon group(90%vs.44%,χ^(2)=7.935,P=0.005;90%vs.57%,χ^(2)=4.309,P=0.038).The detection rate of micrometastasis in SLN of ICG group was significantly different from nanocarbon group(35%vs.15%,χ^(2)=5.853,P=0.016).Conclusion ICG fluorescence imaging is superior to nanocarbon in SLN biopsy during laparoscopic radical right hemicolectomy,especially when patients'BMI≥24 kg/m^(2) and tumor diameter≥3 cm.