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目的探讨纳米碳淋巴示踪剂在腹腔镜辅助下进展期胃癌根治术中的淋巴结示踪效果及其应用价值。方法前瞻性收集2014年3-9月期间郑州大学附属肿瘤医院收治的42例进展期胃癌患者,随机分为纳米碳组和对照组,每组21例。纳米碳组患者术中应用腹腔镜辅助下输液针注射法于肿瘤周边浆膜下注射稀释后的纳米碳混悬液,再行胃癌根治术;对照组患者行常规腹腔镜辅助下胃癌根治术。对2组患者的淋巴结检出情况、检出时间及围手术期并发症进行比较。结果纳米碳组共检出淋巴678枚,对照组共检出淋巴结447枚;纳米碳组检出淋巴结数为(32.28±4.10)枚/例,高于对照组的(21.28±2.74)枚/例(P<0.05);纳米碳组的淋巴结检出时间为(24.09±3.58)min,短于对照组的(32.76±4.76)min(P<0.05);纳米碳组≤5 mm淋巴结的检出率高于对照组〔71.68%(486/678)比48.99%(219/447),P<0.01〕。纳米碳组检出淋巴结中黑染506枚(74.63%),黑染淋巴结组的转移率为26.28%(133/506),高于未黑染淋巴结组(6.40%,11/172)和对照组(19.24%,86/447),差异均有统计学意义(P<0.05)。经术中、术后观察及随访,未发现纳米碳混悬液导致的不良反应。结论纳米碳淋巴示踪剂在腹腔镜辅助下进展期胃癌根治术淋巴结清扫中具有良好的示踪效果,淋巴结检出数量明显提高,尤其是对微小淋巴结的检出率更高,提示其安全可行。
Objective To investigate the effect and clinical value of nano-carbon lymphatic tracer on lymph node metastasis in radical gastrectomy assisted with laparoscopy. Methods Forty-two patients with advanced gastric cancer admitted from Cancer Hospital Affiliated to Zhengzhou University from March to September 2014 were prospectively collected and randomly divided into carbon nano group and control group, with 21 cases in each group. Laparoscopic assisted infusion needle injection was used in patients with nano-carbon group to inject the diluted nano-carbon suspension in the subserosal periphery of the tumor, followed by radical gastrectomy. Patients in the control group underwent conventional laparoscopic-assisted radical gastrectomy. Two groups of patients with lymph node detection, detection time and perioperative complications were compared. Results A total of 678 lymph nodes were detected in the nanocarbon group, while 447 lymph nodes were detected in the control group. The number of lymph nodes in the nanocarbon group was (32.28 ± 4.10) pieces / (21.28 ± 2.74) / cases (P <0.05). The detection time of lymph nodes was (24.09 ± 3.58) min in the carbon nanocarbon group, which was shorter than that in the control group (32.76 ± 4.76) min (P <0.05) Higher than the control group (71.68% (486/678) vs 48.99% (219/447), P <0.01). There were 506 black stained lymph nodes (74.63%) in the nano-carbon group and 26.28% (133/506) in the black stained lymph node group, which were significantly higher than those in the non-stained lymph node group (6.40%, 11/172) (19.24%, 86/447), the differences were statistically significant (P <0.05). After surgery, postoperative observation and follow-up, no adverse reaction caused by nano-carbon suspension was found. Conclusion Nano-carbon lymphatic tracer has a good tracing effect in laparoscopic-assisted radical gastrectomy for lymph node dissection of gastric cancer. The number of lymph node detection is significantly increased, especially for the detection of small lymph nodes, suggesting that it is safe and feasible .