纳米碳示踪技术在胰头部恶性肿瘤行精准胰十二指肠切除术中的应用
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摘要
目的探讨纳米碳示踪剂在胰头部肿瘤行精准胰十二指肠切除术中的应用。方法选取临沂市中心医院普外二科2016年3月~2017年12月收治的65例胰头癌患者为研究对象,按随机数字表法随机分为实验组与对照组。实验组32例,男17例,女15例,年龄33~71岁,将纳米碳混悬液注入胰头部上、中、下三个部位,进行淋巴示踪。对照组33例,男18例,女15例,年龄35~72岁,未应用纳米碳示踪技术。术后对切除标本中淋巴结检出数量、被纳米碳黑染的淋巴结数量、淋巴结超过15枚病例数量、直径小于3mm的微小淋巴结数量、癌转移淋巴结数量、癌转黑染移淋巴结数量,进行比较分析。结果所有65例胰头恶性肿瘤患者均完成全胰腺系膜切除的胰十二指肠切除术,并进行标准淋巴结清扫,术后病理均证实为胰头部恶性肿瘤。两组术后标本共检出淋巴结1009,其中实验组(18.16±3.05)枚/例、对照组(12.97±4.71)枚/例,P<0.01。实验组检出微小淋巴结124枚,对照组检出微小淋巴结67枚。实验组检出淋巴结转移率与对照组比较无明显差异,P>0.05。实验组检出黑染淋巴结352枚,其中癌转移淋巴结71枚,未黑染淋巴结229枚,其中癌转移淋巴结27枚,黑染淋巴结癌转移率明显高于未黑染淋巴结癌转移率,P<0.01。结论纳米碳示踪技术在术中指导手术医师精准清除区域淋巴结,提高了术后切除标本中淋巴结的检出数量,特别是微小淋巴结的检出数量,提高了胰头癌病理分期的准确性。
Objective To investigate the application of carbon nanoparticles technology on accurate pancreatoduodenectomy in pancreatic head cancer.Methods65 cases with pancreatic head cancer patients who were treated in Linyin Centrol Hosptial from March 2016 to December 2017 were randomly divided into experimental group(32 cases)and control group(33 cases),For the experimental group,32 patients,carbon nanoparticles was injected at 3 locations in pancreatic head,and for the control group,32 patients,without carbon nanoparticles.After operation,the total number of lymph nodes,number of tiny lymph nodes,number of black dye and number of metastasis lymph node confirmed by pathology in the two groups were statistical analysised.Results There were 1009 pieces of lymph node seized in two groups toally,including(18.16±3.05)medals in carbon nanoparticles group and(12.97±4.71)medals in control group.Lymph node number in carbon nanoparticles group was more than control group(P <0.01).carbon nanoparticles group seized 124 tiny lymph nodes,significantly higher than 67 in the control group(P <0.05).The metastasis rate of lymph node was no significant difference in the two groups(P >0.05).carbon nanoparticles group seized lymph node metastasis was no significant difference in the rate of the control group(P >0.05).carbon nanoparticles group seized 352 black dyed lymph nodes and 229 not black dye lymph nodes.And 71 cases of metastasis lymph nodes in Black dye lymph nodes,27 cases of metastasis lymph nodes in not the black dye lymph nodes.The metastasis rate of black dye lymph node was higher(P <0.01).Conclusion Carbon nanoparticles technology can guide the surgeon to accurately lymph nodes dissection during the operation,and can add to the number of lymph nodes in the postoperative surgical specimens,improve lymph nodes in patients with pancreatic head cancer radical seized quantity.carbon nanoparticles technique can ensure the accuracy of the pathological staging,there was important clinical significance to lymph node dissection in pancreatic head cancer.
Objective To investigate the application of carbon nanoparticles technology on accurate pancreatoduodenectomy in pancreatic head cancer.Methods65 cases with pancreatic head cancer patients who were treated in Linyin Centrol Hosptial from March 2016 to December 2017 were randomly divided into experimental group(32 cases)and control group(33 cases),For the experimental group,32 patients,carbon nanoparticles was injected at 3 locations in pancreatic head,and for the control group,32 patients,without carbon nanoparticles.After operation,the total number of lymph nodes,number of tiny lymph nodes,number of black dye and number of metastasis lymph node confirmed by pathology in the two groups were statistical analysised.Results There were 1009 pieces of lymph node seized in two groups toally,including(18.16±3.05)medals in carbon nanoparticles group and(12.97±4.71)medals in control group.Lymph node number in carbon nanoparticles group was more than control group(P <0.01).carbon nanoparticles group seized 124 tiny lymph nodes,significantly higher than 67 in the control group(P <0.05).The metastasis rate of lymph node was no significant difference in the two groups(P >0.05).carbon nanoparticles group seized lymph node metastasis was no significant difference in the rate of the control group(P >0.05).carbon nanoparticles group seized 352 black dyed lymph nodes and 229 not black dye lymph nodes.And 71 cases of metastasis lymph nodes in Black dye lymph nodes,27 cases of metastasis lymph nodes in not the black dye lymph nodes.The metastasis rate of black dye lymph node was higher(P <0.01).Conclusion Carbon nanoparticles technology can guide the surgeon to accurately lymph nodes dissection during the operation,and can add to the number of lymph nodes in the postoperative surgical specimens,improve lymph nodes in patients with pancreatic head cancer radical seized quantity.carbon nanoparticles technique can ensure the accuracy of the pathological staging,there was important clinical significance to lymph node dissection in pancreatic head cancer.
引文
[1]Jemal A,Siegel R,ward E,et al.Cancer statistics,2009[J].CA Cancer J Clin.2009,59(4):225-249.
[2]金克敏,王立军,刘伟.转移淋巴结数目对胰腺癌患者预后的意义[J].中华普通外科杂志,2016,31(1):17-21.
[3]张维建,方瑶,蒋飞照,等.无淋巴结转移胰腺癌的临床病理特点和预后分析[J].中华胰腺病杂志,2015,15(6):409-411.
[4]崔世昌,刘成彪,史宪杰,等.不同TNM分期胰腺癌患者根治性切除术疗效分析[J].国际外科学杂志,2015,42(6):376-379.
[5]Liu CL,Yang TL,Chen BF.Sentinel lymph node mapping with emulsion of activated carbon particles in patients with pre-mastectomy diagnosis of intraductal carcinoma of the breast[J].J Chin Med Assoc,2013,76(7):406-410.
[6]Hao RT,Chen J,Zhao LH,et al.Sentinel lymph node biopsy using carbon nanoparticles for Chinese patients with papillary thyroid microcarcinoma[J].EUR J Surg Oncol,2012,38(8):718-724.
[7]Jang JY,Kang MJ,Heo JS,et al.A prospective randomized controlled study comparing outcomes of standard resection and extended resection,including dissection of the nerve plexus and various lymph nodes,in patients with pancreatic head cancer[J].Ann Surg,2014,259(4):656-664.
[8]罗国培,肖志文,刘祖强,等.胰腺癌淋巴转移诊治进展与处理规范[J].中国癌症杂志,2014,24(2):81-86.
[9]中华医学会外科学分会胰腺外科学组.胰腺癌诊治指南(2014版)[J].中华消化外科杂志,2014,13(11):831-837.
[10]崔世昌,夏云强,顾万清,等.Ⅲ期胰腺癌患者根治性手术的可行性[J].中华肝胆外科杂志,2016,22(2):103-106.
[11]Wittel UA,Makdomized F,Sick O,et al.Retrospective analyses of trends in pancreatic surgery:indications,operative techniques,and postoperative outcome of 1120pancreatic resections[J].World J Surg Oncol,2015,13(7):102-106.
[12]Polom K,Roviello G,Generali D,et al.Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for treatment of ovarian cancer[J].Int J Hyperthermia,2016,32(2):298-310.
[13]Montgomery L L,Thorne A C,Van Zee K J,et al.Isosulfan blue dye reactions during sentinel lymph node mapping for breast cancer[J].Anesth Analg,2016,95(2):385-388.
[14]Adham M,Singhirunnusom J.surgical technique and results of total mesopancreas excision(TMpE)in pancreatic tumors[J].Eur J Surg Oncol,2012,38(4):340-345.
[15]金钢,郑楷炼.胰十二指肠切除术手术入路探讨与评价[J].中国实用外科杂志,2016,36(8):829-833.
[16]Balaban EP,Mangu PB,Yee NS.Locally advanced unresectable pancreatic cancer:American Society of Clinical Oncology Clinical Practice Guideline Summary[J].J Oncol Pract,2017,13(4):265-269.
[17]Hartwig W,Gluth A,Hinz U,et al.Outcomes after extended pancreatectomy in patients with borderline resectable and locally advanced pancreatic cancer[J].Br J Surg,2016,103(12):1683-1694.
[18]苗毅.规范化实施胰十二指肠切除术几个关键问题[J].中国实用外科杂志,2016,36(8):821-824.
[19]Ying H,Dey P,Yao W,et al.Genetics and biology of pancreatic ductal adenocarcinoma[J].Genes Dev,2016,30(4):355-385.
[2]金克敏,王立军,刘伟.转移淋巴结数目对胰腺癌患者预后的意义[J].中华普通外科杂志,2016,31(1):17-21.
[3]张维建,方瑶,蒋飞照,等.无淋巴结转移胰腺癌的临床病理特点和预后分析[J].中华胰腺病杂志,2015,15(6):409-411.
[4]崔世昌,刘成彪,史宪杰,等.不同TNM分期胰腺癌患者根治性切除术疗效分析[J].国际外科学杂志,2015,42(6):376-379.
[5]Liu CL,Yang TL,Chen BF.Sentinel lymph node mapping with emulsion of activated carbon particles in patients with pre-mastectomy diagnosis of intraductal carcinoma of the breast[J].J Chin Med Assoc,2013,76(7):406-410.
[6]Hao RT,Chen J,Zhao LH,et al.Sentinel lymph node biopsy using carbon nanoparticles for Chinese patients with papillary thyroid microcarcinoma[J].EUR J Surg Oncol,2012,38(8):718-724.
[7]Jang JY,Kang MJ,Heo JS,et al.A prospective randomized controlled study comparing outcomes of standard resection and extended resection,including dissection of the nerve plexus and various lymph nodes,in patients with pancreatic head cancer[J].Ann Surg,2014,259(4):656-664.
[8]罗国培,肖志文,刘祖强,等.胰腺癌淋巴转移诊治进展与处理规范[J].中国癌症杂志,2014,24(2):81-86.
[9]中华医学会外科学分会胰腺外科学组.胰腺癌诊治指南(2014版)[J].中华消化外科杂志,2014,13(11):831-837.
[10]崔世昌,夏云强,顾万清,等.Ⅲ期胰腺癌患者根治性手术的可行性[J].中华肝胆外科杂志,2016,22(2):103-106.
[11]Wittel UA,Makdomized F,Sick O,et al.Retrospective analyses of trends in pancreatic surgery:indications,operative techniques,and postoperative outcome of 1120pancreatic resections[J].World J Surg Oncol,2015,13(7):102-106.
[12]Polom K,Roviello G,Generali D,et al.Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for treatment of ovarian cancer[J].Int J Hyperthermia,2016,32(2):298-310.
[13]Montgomery L L,Thorne A C,Van Zee K J,et al.Isosulfan blue dye reactions during sentinel lymph node mapping for breast cancer[J].Anesth Analg,2016,95(2):385-388.
[14]Adham M,Singhirunnusom J.surgical technique and results of total mesopancreas excision(TMpE)in pancreatic tumors[J].Eur J Surg Oncol,2012,38(4):340-345.
[15]金钢,郑楷炼.胰十二指肠切除术手术入路探讨与评价[J].中国实用外科杂志,2016,36(8):829-833.
[16]Balaban EP,Mangu PB,Yee NS.Locally advanced unresectable pancreatic cancer:American Society of Clinical Oncology Clinical Practice Guideline Summary[J].J Oncol Pract,2017,13(4):265-269.
[17]Hartwig W,Gluth A,Hinz U,et al.Outcomes after extended pancreatectomy in patients with borderline resectable and locally advanced pancreatic cancer[J].Br J Surg,2016,103(12):1683-1694.
[18]苗毅.规范化实施胰十二指肠切除术几个关键问题[J].中国实用外科杂志,2016,36(8):821-824.
[19]Ying H,Dey P,Yao W,et al.Genetics and biology of pancreatic ductal adenocarcinoma[J].Genes Dev,2016,30(4):355-385.