3D腹腔镜联合纳米炭示踪剂在远端胃癌根治术中的应用
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摘要
目的探究3D腹腔镜联合纳米炭示踪剂行远端胃癌根治术的疗效。方法回顾性分析2014年1月至2016年3月潍坊市人民医院为82例病人行纳米炭引导下3D腹腔镜辅助远端胃癌根治术治疗的临床资料,记录围手术期情况,总结其治疗效果。结果 82例病人均顺利完成手术,手术时间(205. 3±23. 2) min,术中出血量(105. 7±22. 3) mL,术后排气时间(2. 1±0. 5) d,术后住院时间(8. 5±1. 3) d;术后腹腔出血1例,吻合口瘘2例;共检获淋巴结2 567枚,平均(31. 3±4. 3)枚,黑染淋巴结总数1 930枚,黑染率75. 2%,黑染淋巴结转移个数为737枚,黑染淋巴结转移率38. 2%,未黑染淋巴结转移率13. 2%,淋巴结总转移率32. 0%。结论纳米炭示踪剂具有良好的淋巴结示踪效果,3D腹腔镜联合纳米炭示踪剂行远端胃癌根治术是安全、有效、可行的。
Objective To explore the efficacy of 3 D laparoscopic combined with nanocarbon tracer in radical distal gastrectomy for gastric cancer. Methods Clinical data of 82 patients who accepted assisted laparoscopic radical distal gastrectomy for gastric cancer guided by nanocarbon tracer form January 2014 to March 2016 were retrospectively analyzed. The perioperative situations were recorded and the treatment outcomes were summarized. Results The operations of 82 patients were successfully completed. The average operationtime was(205. 3 ± 23. 2) min and the average amount of bleeding during operation was(105. 7 ± 22. 3) mL. The time to first postoperative flatus was(2. 1 ± 0. 5) d and the average postoperative hospital stay was(8. 5 ± 1. 3) d. There were 1 case of abdominal bleeding and 2 cases of anastomotic fistula. Total of 2 567 lymph nodes were detected,with an average of(31. 3 ± 4. 3) lymph nodes. There were1 930 black stained lymph nodes. Black dye rate was 75. 2%. The number of black stained lymph node metastasis was 737 and the rate of that was 38. 2%. The unstained lymph node metastasis rate was 13. 2% and the lymph node total metastasis rate was 32. 0%. Conclusion Nanocarbon tracer has good effect on lymph node tracing. 3 D laparoscopic combined with nanocarbon tracer in radical distal gastrectomy for gastric cancer is safe,effective and feasible.
Objective To explore the efficacy of 3 D laparoscopic combined with nanocarbon tracer in radical distal gastrectomy for gastric cancer. Methods Clinical data of 82 patients who accepted assisted laparoscopic radical distal gastrectomy for gastric cancer guided by nanocarbon tracer form January 2014 to March 2016 were retrospectively analyzed. The perioperative situations were recorded and the treatment outcomes were summarized. Results The operations of 82 patients were successfully completed. The average operationtime was(205. 3 ± 23. 2) min and the average amount of bleeding during operation was(105. 7 ± 22. 3) mL. The time to first postoperative flatus was(2. 1 ± 0. 5) d and the average postoperative hospital stay was(8. 5 ± 1. 3) d. There were 1 case of abdominal bleeding and 2 cases of anastomotic fistula. Total of 2 567 lymph nodes were detected,with an average of(31. 3 ± 4. 3) lymph nodes. There were1 930 black stained lymph nodes. Black dye rate was 75. 2%. The number of black stained lymph node metastasis was 737 and the rate of that was 38. 2%. The unstained lymph node metastasis rate was 13. 2% and the lymph node total metastasis rate was 32. 0%. Conclusion Nanocarbon tracer has good effect on lymph node tracing. 3 D laparoscopic combined with nanocarbon tracer in radical distal gastrectomy for gastric cancer is safe,effective and feasible.
引文
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[12]官国先,张祥福,卢辉山,等.根治性全胃切除术治疗进展期贲门癌的疗效评价[J].中华普通外科杂志,2006,21(8):564-565,576.
[13] BOUVIER AM,HAAS O,PIARD F,et al. How many nodes must be examined to accurately stage gastric carcinomas? Results from a population based study[J]. Cancer,2002,94(11):2862-2866.
[14] CHIKURA T,OGAWA T,CHOCHK,et a1. Minimum number of lymph nodes that should be examined for the International union Against Cancer/American Joint committee on Cancer TNM classification of gastric carcinoma[J]. World J Surg,2003,27(3):330-333.
[15]张静,孙梅林. 3D腹腔镜下前列腺癌根治术的护理配合[J].安徽医药,2015,19(1):179-180.
[2] MCLACHLAN G. From 2D to 3D:the future of surgery?[J]. Lancet,2011,378(9800):1368.
[3] LUSCH A,BUCUR PL,MENHADJI AD,et al. Evaluation of the impact of three-dimensional vision on laparoscopic performance[J]. J Endourol,2014,28(2):261-266.
[4]臧潞,胡伟国,郑民华.腹腔镜胃癌根治术并发症及其预防[J].中华胃肠外科杂志,2013,16(10):940-943.
[5]洪清琦,罗琪,黄正接,等. 3D高清腹腔镜在腹腔镜辅助胃癌根治性全胃切除术中的应用[J].中国微创外科杂志,2015,15(11):976-978.
[6]张国庆,亓林,陈运.传统2D腹腔镜与3D腹腔镜手术治疗肾上腺瘤的疗效比较[J].安徽医药,2015,19(7):1334-1336.
[7]陈海宁,张波,陈秀峰,等.纳米炭在胃癌根治术中的临床应用研究[J].中国普外基础与临床杂志,2011,18(2):149-152.
[8]张波,陈佳平,胡建昆.纳米炭混悬注射液检测胃癌前哨淋巴结的临床研究[J].华西医学,2006,21(3):514-515.
[9] LI Y,JIAN WH,GUO ZM,et al. A meta-analysis of carbon nanoparticles for identifying lymph nodes and protecting parathyroid glands during surgery[J]. Otolaryngol Head Neck Surg,2015,152(6):1007-1016.
[10] YAN J,ZHENG X,LIU Z,et al. A multicenter study of using carbon nanoparticles to show sentinel lymph nodes in early gastric cancer[J]. Surg Endosc,2016,30(4):1294-1300.
[11] JIANG Y,LIN N,HUANG S,et al. Tracking nonpalpable breast cancer for breast-conserving surgery with carbon nanoparticles:implication in tumor location and lymph node dissection[J]. Medicine(Baltimore),2015,94(10):e605. DOI:10. 1097/MD. 0000000000000605.
[12]官国先,张祥福,卢辉山,等.根治性全胃切除术治疗进展期贲门癌的疗效评价[J].中华普通外科杂志,2006,21(8):564-565,576.
[13] BOUVIER AM,HAAS O,PIARD F,et al. How many nodes must be examined to accurately stage gastric carcinomas? Results from a population based study[J]. Cancer,2002,94(11):2862-2866.
[14] CHIKURA T,OGAWA T,CHOCHK,et a1. Minimum number of lymph nodes that should be examined for the International union Against Cancer/American Joint committee on Cancer TNM classification of gastric carcinoma[J]. World J Surg,2003,27(3):330-333.
[15]张静,孙梅林. 3D腹腔镜下前列腺癌根治术的护理配合[J].安徽医药,2015,19(1):179-180.