胃癌术中纳米碳分区示踪对提高淋巴结分拣数的临床价值  

Clinical value of carbon nanoparticles tracer in gastric cancer surgery to increase the number of lymph nodes retrieval

作　　者：蔡耀庆[1] 梁月祥 余书勇 涂瑞沙 Cai Yaoqing;Liang Yuexiang;Yu Shuyong;Tu Ruisha(Department of Gastrointestinal Surgery,Hainan Cancer Hospital,Haikou,Hainan 570312,China;Department of Gastrointestinal Oncology,the First Affiliated Hospital,Hainan Medical University,Haikou,Hainan 570102,China)

机构地区：[1]海南省肿瘤医院胃肠外科,海口570312 [2]海南医学院第一附属医院胃肠肿瘤外科,海口570102

出　　处：《中华胃肠外科杂志》2020年第10期984-989,共6页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的:术中纳米碳示踪有助于胃癌淋巴结清扫并可以增加淋巴结检出数目,但传统纳米碳示踪方法示踪范围较小,区分能力有限。本研究探讨纳米碳分区示踪在胃癌淋巴结分拣中的临床价值。方法:本研究采用回顾性队列研究方法。收集2015年12月至2019年2月期间,海南医学院第一附属医院和海南省肿瘤医院收治的行D 2根治切除并在术中进行纳米碳示踪的胃癌患者临床病理资料,排除术后病理分期为T 1~2、Borrmann Ⅳ型胃癌、远处转移、术前接受新辅助化疗以及临床病理资料不全者。共181例患者纳入本研究(海南医学院第一附属医院113例,海南省肿瘤医院68例),根据不同纳米碳示踪法,分为分区示踪组(89例)和传统示踪组(92例)。传统示踪组在肿瘤边缘正常浆膜0.5 cm处取上、下、左、右4个注射点行浆膜下注射纳米碳0.1~0.3 ml;分区示踪组在其基础上,同时在幽门上胃右动脉入胃第一分支处、幽门下胃网膜右动脉入胃第一分支处、胃小弯胃左动脉入胃第一分支处和胃大弯胃网膜左动脉入胃第一分支处浆膜下各注射纳米碳0.1~0.3 ml。观察分区示踪法对各部位淋巴管和各组淋巴结的显示情况,比较两组黑染淋巴结数、淋巴结黑染率、检出淋巴结总数、阳性淋巴结总数、淋巴结转移率和淋巴结转移度。 结果:分区示踪组与传统示踪组患者基线资料的差异无统计学意义(均 P>0.05)。分区示踪组黑染淋巴结数为多于传统示踪组[中位数:25.0枚比13.5枚, Z=-7.158, P<0.001];淋巴结黑染率为高于传统示踪组[(70.8±12.0)%比(47.1±15.7)%, t=11.399, P<0.001]。分区示踪组检出淋巴结总数和阴性淋巴结总数均高于传统示踪组,差异具有统计学意义[淋巴结总数:(37.5±11.5)枚比(29.6±11.8)枚, t=4.581, P<0.001;阴性淋巴结总数:(31.3±12.5)枚比(24.9±11.1)枚, t=3.621, P<0.001]。分区示踪组与传统示踪组的阳性淋巴结总数[中�Objective To investigate the clinical value of carbon nanoparticles zonal tracer technique in lymph node retrieval of gastric cancer(GC).Methods A retrospective cohort study was carried out.Clinicopathological data of GC patients who underwent radical D2 resection with carbon nanoparticles tracer in The First Affiliated Hospital of Hainan Medical University and Hainan Cancer Hospital from December 2015 and February 2019 were collected.Those with postoperative pathology of T1-2,Borrmann IV type GC,distant metastasis,preoperative neoadjuvant chemotherapy and incomplete data were excluded.A total of 181 patients were enrolled in this study,including 113 cases from the First Affiliated Hospital of Hainan Medical University and 68 cases from Hainan Cancer Hospital.Patients were categorized into two groups based on the methods of carbon nanoparticles tracer:zonal tracer group and traditional tracer group.In the traditional tracer group,0.1-0.3 ml of carbon nanoparticle was injected subserously at the upper,lower,left and right 4 injection points 0.5 cm away from the edge of the tumor in the normal serous membrane.In the zonal tracer group,on the basis of the traditional tracer group,0.1-0.3 ml of carbon nanoparticle was injected subserously at the first branch of the suprapyloric right gastric artery into the stomach,the first branch of the subpyloric right gastroepiploic artery into the stomach,the first branch of the minor curvature left gastric artery into the stomach and the first branch of the greater curvature left gastroepiploic artery into the stomach,respectively.The display of lymphatic vessels in each location and lymph nodes in each group by the tracing method was observed.The number of black-stained lymph nodes,the black staining rate of lymph nodes,the total number of detected lymph nodes,the total number of positive lymph nodes,and the metastatic rate of lymph node were compared between the two groups.Results Eighty-nine patients were assigned to zonal tracer group,and 92 patients to traditional tracer g

关 键 词：胃肿瘤 淋巴结分拣 纳米碳 

分 类 号：R735.2[医药卫生—肿瘤]