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目的探讨腹腔镜下食管胃交界腺癌手术中使用纳米炭淋巴示踪剂引导手术清扫淋巴结的可行性和临床效果。方法回顾性分析2008～2011年期间我院行腹腔镜下食管胃交界腺癌手术119例患者的临床资料,征得患者知情同意后应用改制的注射针在腹腔镜下于肿瘤周围浆膜下注射纳米炭后行腹腔镜辅助近侧胃切除56例(研究组),未行纳米炭示踪注射行腹腔镜辅助近侧胃切除63例(对照组),比较2组患者的清扫淋巴结枚数、转移淋巴结枚数以及手术指标(手术时间、术中出血量)和术后住院时间。结果 2组患者均顺利完成手术,研究组术前在肿瘤周围浆膜下纳米炭注射均成功。结果显示,研究组淋巴结检出枚数及转移淋巴结枚数均明显多于对照组〔检出淋巴结(:20.52±4.51)枚比(16.44±3.80)枚,t=5.341,P=0.000;转移淋巴结:(8.88±3.15)枚比(6.49±2.49)枚,t=4.602,P=0.000〕;研究组的术中出血量、手术时间及术后住院时间与对照组比较,差异均无统计学意义〔术中出血量(:97.50±27.52)ml比(96.03±22.83)ml,t=0.318,P=0.751;手术时间(:221.07±24.25)min比(230.48±38.54)min,t=-1.570,P=0.119;术后住院时间(10.82±1.67)d比(10.29±1.33)d,t=1.945,P=0.054〕。结论在腹腔镜下食管胃交界腺癌手中应用纳米炭淋巴示踪剂,操作简单、易行,能增加术后淋巴结的送检数目,不增加术中出血量、手术时间和术后住院时间。
Objective To investigate the feasibility and clinical efficacy of laparoscopic transabdominal adenocarcinoma using nanocarbon lymphatic tracer to guide lymph node dissection. Methods The clinical data of 119 patients with laparoscopic esophageal and gastric adenocarcinoma in our hospital from 2008 to 2011 were analyzed retrospectively. After receiving the informed consent of the patients, the patients were treated with subcutaneous injection of laparoscopic subserosal injection 56 patients underwent laparoscopic-assisted proximal gastrectomy (study group) and no carbon nanocarbon tracer injection assisted laparoscopic assisted proximal gastrectomy at 63 patients (control group). The number of lymph nodes and the number of metastases The number of lymph nodes and surgical indicators (operation time, intraoperative blood loss) and postoperative hospital stay. Results The patients in both groups were successfully performed. The study group was successfully treated with subcaposite nanocarbon injection before the operation. The results showed that the number of detected lymph nodes and the number of metastatic lymph nodes in the study group were significantly more than those in the control group (16.44 ± 3.80, t = 5.341, P = 0.000); lymph node metastasis 8.88 ± 3.15) (6.49 ± 2.49, t = 4.602, P = 0.000). There was no significant difference in the amount of blood loss, operation time and postoperative hospital stay between the two groups The mean bleeding time was (97.50 ± 27.52) ml (96.03 ± 22.83) ml, t = 0.318, P = 0.751. The operative time was (221.07 ± 24.25) min and the difference was (230.48 ± 38.54) 0.119; postoperative hospital stay (10.82 ± 1.67) d (10.29 ± 1.33) d, t = 1.945, P = 0.054〕. Conclusion The application of nanocarbon lymphatic tracer in the treatment of laparoscopic esophageal-gastric adenocarcinoma is simple and easy to operate. It can increase the number of postoperative lymph node dissemination without increasing intraoperative blood loss, operation time and postoperative hospital stay.