纳米炭注射液在壶腹部癌淋巴结清扫中的应用  

Application of carbon nanoparticles injection in lymphadenectomy for ampullary carcinoma

作　　者：李琪 黄晓珺 刘利平 李明岳 刘嘉林 LI Qi;HUANG Xiaojun;LIU Liping;LI Mingyue;LIU Jialin(Department of Hepatobiliary Surgery,Shenzhen People's Hospital,the Second Clinical Medical College of Jinan University,Shenzhen,Guangdong 518020,China)

机构地区：[1]暨南大学第二临床医学院深圳市人民医院肝胆外科,广东深圳518020

出　　处：《中国普通外科杂志》2019年第2期206-211,共6页China Journal of General Surgery

基　　金：广东省深圳市科技创新资助项目(JCYJ20150403101028193)

摘　　要：目的:探索纳米炭注射液在壶腹部癌术中指导淋巴结清扫的作用。方法:选择壶腹部癌患者60例,分为观察组和对照组,每组30例,观察组患者暴露术野后,取纳米炭注射液1mL,在癌旁周缘的十二指肠降段浆膜及胰头包膜下分上、下、左、右4点注射,对照组则以相同的方式注射取生理盐水。比较两组手术中清扫淋巴结的数目及其他相关临床指标。结果:观察组总淋巴结清扫数为468枚,其中416枚黑染(88.9%);对照组总淋巴结清扫数为268枚;观察组平均淋巴结清扫数明显高于对照组[(15.23±2.13)枚/例vs.(9.77±1.33)枚/例,P<0.01],差异主要在于N1站淋巴结(P=0.002),两组N2、N3淋巴结清扫数均无统计学差异(均P>0.05)。两组手术时间、淋巴漏的发生率、住院时间均无统计学差异(均P>0.05),但观察组术中出血量明显少于对照组[(318±30)mLvs.(592±60)mL,P<0.05)。结论:纳米炭注射液在壶腹部癌根治术中可提高淋巴结清扫数目,减少术中出血量,且不增加并发症发生率,是一种安全有效的示踪剂。Objective:To investigate the guiding effect of carbon nanoparticles injection on lymph node clearance during surgery for carcinoma of the ampulla of Vater.Methods:Sixty patients with carcinoma of the ampulla of Vater were selected and allocated to observation group and control group,with 30 cases in each group.Patients in observation group underwent injection of 1 mL carbon nanoparticles with 4 points(top,bottom,left and right)into the serosa of the descending duodenum and the capsule of the pancreatic head around the tumor after laparotomy and the operative field exposure,while those in control group underwent saline injection in the same fashion.The number of dissected lymph nodes and other relevant clinical variables were compared between the two groups of patients.Results:The total number of dissected lymph nodes in observation group was 468,including 416(88.9%)dark stained lymph nodes.The total number of dissected lymph nodes in control group was 268.The average number of dissected lymph nodes per case in observation group was significantly greater than that in control group(15.23±2.13 vs.9.77±1.33,P<0.01),which was mainly responsible for the N1 station lymph nodes(P=0.002),and the differences in N2 and N3 dissected lymph nodes showed no significant differences between the two groups(both P>0.05).The operative time,incidence of lymphatic leakage and length of hospital stay showed no significant differences between the two groups(all P>0.05),but the intraoperative blood loss was significantly reduced in observation group compared with control group[(318±30)mL vs.(592±60)mL,P<0.05].Conclusion:Carbon nanoparticle injection in radical surgery for carcinoma of the ampulla of Vater can increase the number of dissected lymph nodes,reduce intraoperative blood loss,and with no increase of occurrence of complications.It is a safe and effective tracer.

关 键 词：肝胰管壶腹肿瘤/外科学 淋巴结切除术 染色与标记 

分 类 号：R735[医药卫生—肿瘤]