纳米炭注射液在壶腹部癌淋巴结清扫中的应用
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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.
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.
引文
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[13]Long M,Luo D,Diao F,et al.A Carbon Nanoparticle Lymphatic Tracer Protected Parathyroid Glands During Radical Thyroidectomy for Papillary Thyroid Non-Microcarcinoma[J].Surg Innov,2017,24(1):29-34.doi:10.1177/1553350616668088.
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[15]陈舒婷,邱建国,员海超,等.胰十二指肠切除术联合扩大淋巴结清扫治疗壶腹周围癌疗效的系统评价[J].世界华人消化杂志,2013,21(34):3887-3893.Chen ST,Qiu JG,Yuan HC,et al.Standard vs extended lymphadenectomy associated with pancreaticoduodenectomy for periampullary adenocarcinoma:A meta-analysis[J].World Chinese Journal of Digestology,2013,21(34):3887-3893.
[16]Chen XZ,Zhang WH,Hu JK.Lymph node metastasis and lymphadenectomy of resectable adenocarcinoma of the esophagogastric junction[J].Chin J Cancer Res,2014,26(3):237-242.doi:10.3978/j.issn.1000-9604.2014.06.17.
[17]Wang Q,Chen E,Cai Y,et al.Preoperative endoscopic localization of colorectal cancer and tracing lymph nodes by using carbon nanoparticles in laparoscopy[J].World J Surg Oncol,2016,14(1):231.doi:10.1186/s12957-016-0987-1.
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[19]Sun SP,Zhang Y,Cui ZQ,et al.Clinical application of carbon nanoparticle lymph node tracer in the VI region lymph node dissection of differentiated thyroid cancer[J].Genet Mol Res,2014,13(2):3432-3437.doi:10.4238/2014.April.30.4.
[20]Strobel O,Hinz U,Gluth A,et a1.Pancreatic adenocarcinoma:number of positive nodes allows to distinguish several Ncategories[J].Ann Surg,2015,261(5):961-969.doi:10.1097/SLA.0000000000000814.
[21]魏树梅,许晓明,宋楷,等.美国癌症联合委员会壶腹部癌分期系统(第8版)对于规范化病理学取材及报告的指导意义[J].中国实用外科杂志,2017,37(5):514-516.Wei SM,Xu XM,Song K,et al.The guidance of the 8th edition of AJCC staging on pathology sampling and reporting for the ampullarycancer[J].Chinese Journal of Practical Surgery,2017,37(5):514-516.
[22]刘颖斌,吴文广.胰头癌根治性切除的范围与争议[J].中华消化外科杂志,2015,14(8):615-618.doi:10.3760/cma.j.issn.1673-9752.2015.08.005.Liu YB,Wu WG.Extent and disputes about radical resection for pancreatic head carcinoma[J].Chinese Journal of Digestive Surgery,2015,14(8):615-618.doi:10.3760/cma.j.issn.1673-9752.2015.08.005.
[23]孙备,李乐.胰腺癌行标准与扩大的胰腺切除术定义与手术范围--2013国际胰腺外科研究组共识解读[J].中国实用外科杂志,2015,35(1):11-15.Sun B,Li L.The definition and excision extension of standard pancreatectomy and extended pancreatectomy-2013:interpretation of the International Study Group on Pancreatic Surgery by the consensus[J].Chinese Journal of Practical Surgery,2015,35(1):11-15.
[24]田毅峰,王耀东,邱福南,等.规范化区域淋巴结清扫在胰十二指肠切除术中的价值及意义[J].中华肝胆外科杂志,2009,15(3):202-204.doi:10.3760/cma.j.issn.1007-8118.2009.03.016.Tian YF,Wang YD,Qiu FN,et al.Value of standardized regional lymph node clearance for pancreaticoduodenectomy[J].Chinese Journal of Hepatobiliary Surgery,2009,15(3):202-204.doi:10.3760/cma.j.issn.1007-8118.2009.03.016.
[25]邵钦树,叶再元.腹膜后神经、淋巴结及软组织廓清在胰头癌胰十二指肠切除术中的意义[J].中华医学杂志,2010,90(28):1966-1969.doi:10.3760/cma.j.issn.0376-2491.2010.28.007.Shao QS,Ye ZY.Clinical significance of nerve,lymph node and soft tissue dissection in retroperitoneum in radical resection of ductal adenocarcinoma in pancreatic head[J].National Medical Journal of China,2010,90(28):1966-1969.doi:10.3760/cma.j.issn.0376-2491.2010.28.007.
[2]Sunil BJ,Seshadri RA,Gouthaman S,et al.Long-Term Outcomes and Prognostic Factors in Periampullary Carcinoma[J].JGastrointest Cancer,2017,48(1):13-19.doi:10.1007/s12029-016-9863-z.
[3]Mari G,Costanzi A,Monzio N,et al.Small bowel perforation caused by pancreaticojejunal anastomotic stent migration after pancreaticoduodenectomy for periampullary carcinoma[J].JOP,2015,16(2):185-188.doi:10.6092/1590-8577/2957.
[4]黄秀芸,王向阳,杨瑜明,等.壶腹腺癌胰十二指肠切除术后预后相关因素分析[J].中国普通外科杂志,2016,25(9):1247-1252.doi:10.3978/j.issn.1005-6947.2016.09.004.H u a n g X Y,Wa n g X Y,Ya n g Y M,e t a l.P r o g n o s t i c factors for adenocarcinoma of the ampulla of Vater after pancreaticoduodenectomy[J].Chinese Journal of General Surgery,2016,25(9):1247-1252.doi:10.3978/j.issn.1005-6947.2016.09.004.
[5]葛现才,周岩冰,徐宪辉,等.纳米碳示踪技术在腹腔镜结肠癌根治术中的应用[J].中国普通外科杂志,2017,26(4):494-500.doi:10.3978/j.issn.1005-6947.2017.04.015.Ge XC,Zhou YB,Xu XH,et al.Application of carbon nanoparticle tracer technique in radical laparoscopic colon cancer surgery[J].Chinese Journal of General Surgery,2017,26(4):494-500.doi:10.3978/j.issn.1005-6947.2017.04.015.
[6]任明,高国宇,郭嵩.纳米碳对甲状腺癌手术中甲状旁腺的保护作用[J].中国普通外科杂志,2017,26(11):1489-1493.doi:10.3978/j.issn.1005-6947.2017.11.019.Ren M,Gao GY,Guo S.Protective effect of nanocarbon on parathyroid glands during thyroid cancer operation[J].Chinese Journal of General Surgery,2017,26(11):1489-1493.doi:10.3978/j.issn.1005-6947.2017.11.019.
[7]关毅,郭文斌,高伟,等.纳米碳对乳腺癌腋窝前哨淋巴结活检的应用价值[J].中国现代药物应用,2013,7(5):1-2.doi:10.3969/j.issn.1673-9523.2013.05.001.Guan Y,Guo WB,Gao W,et al.Application of a carbon nanoparticle suspension injection into the mammary gland in the sentinel lymph node biopsy for breast cancer[J].Chinese Journal of Modern Drug Application,2013,7(5):1-2.doi:10.3969/j.issn.1673-9523.2013.05.001.
[8]曹永宽,王永华,刘立业,等.手助腹腔镜胃癌淋巴结清扫规范性的临床研究[J].中国普通外科杂志,2012,21(10):1187-1190.Cao YK,Wang YH,Liu LY,et al.Standardization of lymph node dissection in hand-assisted laparoscopic radical gastrectomy for stomach cancer[J].Chinese Journal of General Surgery,2012,21(10):1187-1190.
[9]兰军良,许其威,董晓勇.纳米碳混悬液在胆囊癌淋巴结清扫中的应用[J].肿瘤研究与临床,2015,27(3):192-194.doi:10.3760/cma.j.issn.1006-9801.2015.03.014.Lan JL,Xu QW,Dong XY.Application of carbon nanoparticles suspension in gallbladder carcinoma lymphadenectomy[J].Cancer Research and Clinic,2015,27(3):192-194.doi:10.3760/cma.j.issn.1006-9801.2015.03.014.
[10]Zhang L,Huang Y,Yang C,et al.Application of a carbon nanoparticle suspension for sentinel lymph node mapping in patients with early breast cancer:a retrospective cohort study[J].World J Surg Oncol,2018,16(1):112.doi:10.1186/s12957-018-1414-6.
[11]Du J,Zhang Y,Ming J,et al.Evaluation of the tracing effect of carbon nanoparticle and carbon nanoparticle-epirubicin suspension in axillary lymph node dissection for breast cancer treatment[J].World J Surg Oncol,2016,14(1):164.doi:10.1186/s12957-016-0925-2.
[12]付浩,张朝林,唐振宁,等.纳米碳在甲状腺乳头状癌Ⅵ区淋巴结清扫术中应用的研究[J].临床耳鼻咽喉头颈外科杂志,2017,31(14):1089-1092.doi:10.13201/j.issn.1001-1781.2017.14.009.Fu H,Zhang CL,Tang ZN,et al.Application of carbon nanoparticle in neckⅥlymph node dissection for papillary thyroid carcinoma[J].Journal of Clinical Otorhinolaryngology Head and Neck Surgery,2017,31(14):1089-1092.doi:10.13201/j.issn.1001-1781.2017.14.009.
[13]Long M,Luo D,Diao F,et al.A Carbon Nanoparticle Lymphatic Tracer Protected Parathyroid Glands During Radical Thyroidectomy for Papillary Thyroid Non-Microcarcinoma[J].Surg Innov,2017,24(1):29-34.doi:10.1177/1553350616668088.
[14]Lee SR,Kim HO,Park YL,et.al.Lymph node ratio predicts local recurrence for periampullary tumours[J].ANZ J Surg,2014,84(5):353-358.doi:10.1111/ans.12129.
[15]陈舒婷,邱建国,员海超,等.胰十二指肠切除术联合扩大淋巴结清扫治疗壶腹周围癌疗效的系统评价[J].世界华人消化杂志,2013,21(34):3887-3893.Chen ST,Qiu JG,Yuan HC,et al.Standard vs extended lymphadenectomy associated with pancreaticoduodenectomy for periampullary adenocarcinoma:A meta-analysis[J].World Chinese Journal of Digestology,2013,21(34):3887-3893.
[16]Chen XZ,Zhang WH,Hu JK.Lymph node metastasis and lymphadenectomy of resectable adenocarcinoma of the esophagogastric junction[J].Chin J Cancer Res,2014,26(3):237-242.doi:10.3978/j.issn.1000-9604.2014.06.17.
[17]Wang Q,Chen E,Cai Y,et al.Preoperative endoscopic localization of colorectal cancer and tracing lymph nodes by using carbon nanoparticles in laparoscopy[J].World J Surg Oncol,2016,14(1):231.doi:10.1186/s12957-016-0987-1.
[18]Yan J,Xue F,Chen H,et al.A multi-center study of using carbon nanoparticles to track lymph node metastasis in T1-2 colorectal cancer[J].Surg Endosc,2014,28(12):3315-3321.doi:10.1007/s00464-014-3608-5.
[19]Sun SP,Zhang Y,Cui ZQ,et al.Clinical application of carbon nanoparticle lymph node tracer in the VI region lymph node dissection of differentiated thyroid cancer[J].Genet Mol Res,2014,13(2):3432-3437.doi:10.4238/2014.April.30.4.
[20]Strobel O,Hinz U,Gluth A,et a1.Pancreatic adenocarcinoma:number of positive nodes allows to distinguish several Ncategories[J].Ann Surg,2015,261(5):961-969.doi:10.1097/SLA.0000000000000814.
[21]魏树梅,许晓明,宋楷,等.美国癌症联合委员会壶腹部癌分期系统(第8版)对于规范化病理学取材及报告的指导意义[J].中国实用外科杂志,2017,37(5):514-516.Wei SM,Xu XM,Song K,et al.The guidance of the 8th edition of AJCC staging on pathology sampling and reporting for the ampullarycancer[J].Chinese Journal of Practical Surgery,2017,37(5):514-516.
[22]刘颖斌,吴文广.胰头癌根治性切除的范围与争议[J].中华消化外科杂志,2015,14(8):615-618.doi:10.3760/cma.j.issn.1673-9752.2015.08.005.Liu YB,Wu WG.Extent and disputes about radical resection for pancreatic head carcinoma[J].Chinese Journal of Digestive Surgery,2015,14(8):615-618.doi:10.3760/cma.j.issn.1673-9752.2015.08.005.
[23]孙备,李乐.胰腺癌行标准与扩大的胰腺切除术定义与手术范围--2013国际胰腺外科研究组共识解读[J].中国实用外科杂志,2015,35(1):11-15.Sun B,Li L.The definition and excision extension of standard pancreatectomy and extended pancreatectomy-2013:interpretation of the International Study Group on Pancreatic Surgery by the consensus[J].Chinese Journal of Practical Surgery,2015,35(1):11-15.
[24]田毅峰,王耀东,邱福南,等.规范化区域淋巴结清扫在胰十二指肠切除术中的价值及意义[J].中华肝胆外科杂志,2009,15(3):202-204.doi:10.3760/cma.j.issn.1007-8118.2009.03.016.Tian YF,Wang YD,Qiu FN,et al.Value of standardized regional lymph node clearance for pancreaticoduodenectomy[J].Chinese Journal of Hepatobiliary Surgery,2009,15(3):202-204.doi:10.3760/cma.j.issn.1007-8118.2009.03.016.
[25]邵钦树,叶再元.腹膜后神经、淋巴结及软组织廓清在胰头癌胰十二指肠切除术中的意义[J].中华医学杂志,2010,90(28):1966-1969.doi:10.3760/cma.j.issn.0376-2491.2010.28.007.Shao QS,Ye ZY.Clinical significance of nerve,lymph node and soft tissue dissection in retroperitoneum in radical resection of ductal adenocarcinoma in pancreatic head[J].National Medical Journal of China,2010,90(28):1966-1969.doi:10.3760/cma.j.issn.0376-2491.2010.28.007.
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