摘要
目的探讨纳米炭淋巴结显影技术在术中提高淋巴结切除率及术后病理淋巴结阳性检出率中的应用价值。方法收集2017年3月至2018年2月结直肠癌患者190例,其中男93例,女97例,年龄41~83(57.89±8.65)岁。按术前是否注射纳米炭分为观察组(97例)和对照组(93例),观察组术前24h内在肠镜引导下于肿瘤四周2cm以内的正常黏膜下选取4~5点,每点注射0.2ml左右的纳米活性炭混悬液使黏膜下隆起皮丘;对照组根据CME/TME原则行结直肠癌根治术。比较两组淋巴结检出及转移情况。结果观察组检出淋巴结(15.07±2.23)枚/例,检出直径<5 mm淋巴结(4.69±1.05)枚/例,均高于对照组的(13.04±1.47)枚/例、(2.85±0.83)枚/例(t=7.168、3.096,均P<0.01)。观察组黑染淋巴结的转移率为32.10%,高于未黑染的20.48%(χ~2=9.363,P<0.05)。观察组直径<5 mm转移淋巴结检出(1.80±0.32)枚/例,高于对照组(0.88±0.17)枚/例(t=3.128,P<0.05)。结论纳米炭淋巴结显影可帮助术者提高术中转移淋巴结的切除率,清扫更彻底,同时还能增加微小淋巴结转移灶(<5 mm)和直肠癌术后淋巴结阳性的检出率,使病理分期的准确性判断大大提高。
Objective To evaluate the effect of nano-carbon lymph node visualization technique on lymph node clearance rate in colorectal cancer radical surgery. Methods One hundred and ninety patients with colorectal cancer undergoing radical surgery from March2017 to February 2018 were enrolled in the study. In 30 patients, the nano-carbon was injected in the submucosa around the tumor under the endoscopy 24 h before surgery(study group) and the rest 160 patients received the conventional radical surgery(control group). The detection rate and positive rate of lymph nodes were compared between two groups. Results The number of detected lymph nodes was(15.07±2.23)/case in the study group, which was more than that in the control group(13.04±1.47)/case(t=7.168, P<0.05);the number of lymph nodes <5 mm was(4.69±3.17)/case in study group, which was more than that in control group(2.85 ±2.03)/case(t=3.096, P<0.05). The rate of metastatic lymph nodes in study group was 32.10%, which was higher than that of control group(20.48%, χ~2=9.363, P<0.05). The number of metastatic lymph nodes <5 mm in study group was(1.80±1.53)/case, which was higher than that in the control group(0.88±1.29)/case(t=3.128, P <0.05). Conclusion Nano-carbon lymph node visualization technique can improve the resection rate of metastatic lymph nodes,particularly can increase the detection rate of micro-lymph node metastasis(<5 mm).
作者
陈秋
陈文斌
CHEN Qiu;CHEN Wenbin(Department of Surgery,Changxing Hospital of Traditional Chinese Medicine,Huzhou 313000,China)
出处
《浙江医学》
CAS
2019年第24期2634-2636,2639,共4页
Zhejiang Medical Journal
关键词
纳米活性炭
结直肠癌根治术
淋巴结
转移率
Nano activated carbon
Radical resection of colorectal cancer
Lymph gland
Metastasic rate
