纳米碳和亚甲蓝在结直肠癌根治术淋巴结检出中的应用  

Application of lymph node labeling in colorectal cancer surgery

作　　者：陈涛[1] 华一兵[1] 

机构地区：[1]南京医科大学第一附属医院普外科,江苏南京210029

出　　处：《临床和实验医学杂志》2016年第24期2410-2414,共5页Journal of Clinical and Experimental Medicine

摘　　要：目的探讨纳米碳和亚甲蓝淋巴结示踪剂在结直肠癌根治手术中临床应用的价值和意义。方法将2014年8月至2016年3月102例行结直肠癌根治手术患者随机分为4组;其中25例患者于术前一天在电子肠镜下行肿瘤周围黏膜下纳米碳注射(A组),26例患者于术中在腹腔镜下行肿瘤周围浆膜下纳米碳注射(B组),21例患者于术中在腹腔镜下行肿瘤周围浆膜下亚甲蓝注射(C组),30例患者直接手术(D组)。分析比较各组淋巴结检出数,微小淋巴结(<5 mm)数、染色淋巴结数及淋巴结转移情况;将各组病例根据术后病理分期分别统计淋巴结检出数及染色淋巴结数,不同病理分期间进行分析比较。结果 A组淋巴结平均检出数、平均染色淋巴结数及微小淋巴结检出率均明显高于其余组(P<0.01)。Ⅰ期、Ⅱ期患者平均染色淋巴结数无明显差异(P>0.05),Ⅲ期患者平均染色淋巴结数明显低于Ⅰ期、Ⅱ期,差异有显著性(P<0.01)。各组之间患者转移率(阳性病例总数/病例数)无显著差异;A、B、C三组间的准确性之间无显著差异(P>0.05)。结论术前一天使用纳米碳示踪剂能明显提高淋巴结检出率尤其是微小淋巴结检出率,有助于更准确地进行病理分期,指导术后化疗,改善预后。Objective To investigate the clinical value and significance of lymph node labeling in colorectal cancer surgery.Methods Retrospectively analyze the clinical data of 102 patients with colorectal cancer radical surgery in our department from Feb 2014 to Mar 2016.Among the patients,Carbon nanoparticles were injected into the submucosa around the tumor in 25 patients 1 day before the operation（group A）,carbon nanoparticles were injected into the subserosa around the tumor in 26 patients during the operation（group B）,and methylene blue were injected into the subserosa around the tumor in 21 patients during the operation（group C）,while 30 patients received operation directly（group D）.The number of cleared lymph nodes,tiny lymph nodes（〈5 mm）,dyed lymph nodes,and lymphatic metastasis.The number of cleared lymph nodes and dyed lymph nodes of different pathological stage were analyzed.Results Dyeing lymph node number,the average test results and the average small lymph node detection rate in A group were significantly higher than those in the rest groups（P〈0.01）.Metastatic rate between groups（ the total number of positive cases/cases） had no significant differences; The accuracy of the three groups had no significant difference（P〉0.05）.Conclusion As lymphatic tracer,carbon nanoparticles is better than methylene blue,and using it one day before the operation is superior than during the operation.It can help to improve the lymph node detection rate,the accuracy of pathological staging,and guide the postoperative adjuvant therapy.

关 键 词：结直肠癌 淋巴结示踪 纳米碳 亚甲蓝 

分 类 号：R735.3[医药卫生—肿瘤]