内镜下注射纳米炭在腹腔镜下结直肠癌根治术中的应用
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摘要
目的探讨术前内镜下注射纳米炭在腹腔镜下结直肠癌根治术中的应用价值。方法将2013年3月至2016年1月该院收治的931例结直肠癌患者分为观察组(n=358)和对照组(n=573)。观察组患者于术前1～2d在内镜下注射纳米炭后行腹腔镜下结直肠癌根治术,而对照组患者未进行此操作。结果观察组注射纳米炭后无腹痛、腹泻、发热、穿孔、梗阻等不良反应。观察组平均淋巴结检出数目[(15.31±7.21)枚]多于对照组[(11.05±5.53)枚],淋巴结检出数目大于或等于12枚的患者比例(63.4%)高于对照组(40.1%),差异均有统计学意义(P<0.05)。观察组淋巴结转移率及有淋巴结转移的患者占比(7.3%、34.6%)低于对照组(10.6%、42.1%),差异均有统计学意义(P<0.05)。结论术前内镜下注射纳米炭能有效实现淋巴结示踪,提高淋巴结检出率。
Objective To explore the application value of preoperative endoscopic injection of carbon nanoparticles in laparoscopic radical resection of colorectal cancer.Methods A total of 931 patients with colorectal cancer from March 2013 to January2016 in the hospital were divided in the experimental group(n=358)and the control group(n=573).Patients in the experimental group were treated with laparoscopic radical resection of colorectal cancer after endoscopic injection of carbon nanoparticles 1-2 d before operation,while the atients in the control group were not injected,and the remaining operation was the same as that in the experimental group.Results The experimental group had no adverse reactions,such as abdominal pain,diarrhea,fever,perforation,obstruction after injection of carbon nanoparticles.The average number of lymph nodes detected in the experimental group was higher than that in the control group[(15.31±7.21)pieces vs.(11.05±5.53)pieces,P<0.05].In the experimental group,the number of lymph nodes detected more than 12 of the proportion of patients was 63.4%,higher than that in the control group(40.1%),the lymph node metastasis rate was lower than that in the control group(7.3% vs.10.6%),and the proportion of lymph node metastasis in the experimental group was also lower than that in the control group(34.6%vs.42.1%),the differences were statistically significant(P<0.05).Conclusion Preoperative endoscopic injection of carbon nanoparticles can effectively realize lymph node tracking imaging and improve the detection rate of lymph nodes.
Objective To explore the application value of preoperative endoscopic injection of carbon nanoparticles in laparoscopic radical resection of colorectal cancer.Methods A total of 931 patients with colorectal cancer from March 2013 to January2016 in the hospital were divided in the experimental group(n=358)and the control group(n=573).Patients in the experimental group were treated with laparoscopic radical resection of colorectal cancer after endoscopic injection of carbon nanoparticles 1-2 d before operation,while the atients in the control group were not injected,and the remaining operation was the same as that in the experimental group.Results The experimental group had no adverse reactions,such as abdominal pain,diarrhea,fever,perforation,obstruction after injection of carbon nanoparticles.The average number of lymph nodes detected in the experimental group was higher than that in the control group[(15.31±7.21)pieces vs.(11.05±5.53)pieces,P<0.05].In the experimental group,the number of lymph nodes detected more than 12 of the proportion of patients was 63.4%,higher than that in the control group(40.1%),the lymph node metastasis rate was lower than that in the control group(7.3% vs.10.6%),and the proportion of lymph node metastasis in the experimental group was also lower than that in the control group(34.6%vs.42.1%),the differences were statistically significant(P<0.05).Conclusion Preoperative endoscopic injection of carbon nanoparticles can effectively realize lymph node tracking imaging and improve the detection rate of lymph nodes.
引文
[1]陈万青,张思维,曾红梅,等.中国2010年恶性肿瘤发病与死亡[J].中国肿瘤,2014,23(1):1-10.
[2]李道娟,李倩,贺宇彤.结直肠癌流行病学趋势[J].肿瘤防治研究,2015,42(3):305-310.
[3] KOTAKE K,HONJO S,SUGIHARA K,et al.Number of lymph nodes retrieved is an important determinant of survival of patients with stageⅡand stageⅢcolorectal cancer[J].Jpn J Clin Oncol,2012,42:29-35.
[4] TSAI HL,CHENG KI,LU CY,et al.Prognostic significance of depth of invasion,vascular invasion and numbers of lymph node retrievals in combination for patients with stageⅡcolorectal cancer undergoing radical resection[J].J Surg Oncol,2008,97(5):383-387.
[5] DILLMAN RO,AARON K,HEINEMANN FS,et al.Identification of 12or more lymph nodes in resected colon cancer specimens as an indicator of quality performance[J].Cancer,2009,115(9):1840-1848.
[6] BENSON 3RD AB,VENOOK AP,BEKAII-SAAB T,et al.Colon cancer,version 3[J].J Natl Compr Canc Netw,2014,12:1028-1059.
[7] EDGE SB,COMPTON CC.The American joint committee on cancer:the 7th edition of the AJCC cancer staging manual and the future of TNM[J].Ann Surg Oncol,2010,17(6):1471-1474.
[8]邱成志,吴友谊,王春晓.结直肠癌病检淋巴结数目与TNM分期及预后的关系[J].中华普通外科杂志,2011,26(6):493-495.
[9] XU XF,GU J.The application of Carbon nanoparticles in the lymph node biopsy of cN0papillary thyroid carcinoma:a randomized controlled clinical trial[J].Asian J Surg,2017,40(5):345-349.
[10]ZHANG L.Characteristics of activated carbon nanoparticles and its application in treatment of gastric cancer[J].J Int Oncol,2007,34(1):52-55.
[11]GE J,YAN B,CAO XC.Comparison of sentinel lymph node detection by methylene blue and carbon nanoparticle suspension injection in early breast cancer[J].Chin J Oncol,2011,33:226-228.
[12]CAI HK,HE HF,TIAN W,et al.Colorectal cancer lymph node staining by activated Carbon nanoparticles suspension in vivo or methylene blue in vitro[J].World J Gastroenterol,2012,18(42):6148-6154.
[13]SIEGEL RL,MILLER KD,FEDEWA SA,et al.Colorectal cancer statistics,2017[J].CA Cancer J Clin,2017,67(3):177-193.
[14]SIEGEL R,WARD E,BRAWLEY O,et al.Cancer statistics,2011:the impact of eliminating socioeconomic and racial disparities on premature cancer deaths[J].CA Cancer J Clin,2011,61(4):212-236.
[15]IMAI H,SAWADA K.Complete resection of liver metastases of colorectal cancer after high efficacy bevacizumab,S-1,and CPT-11combination chemotherapy[J].Gan To Kagaku Ryoho,2015,42:101-104.
[16]OKUGAWA Y,INOUE Y,TANAKA K,et al.Loss of the metastasis suppressor gene KiSS1is associated with lymph node metastasis and poor prognosis in human colorectal cancer[J].Oncol Rep,2013,30(3):1449-1454.
[17]HUH J,KIM H,PARK Y,et al.Mismatch repair system and p53expression in patients with T1and T2colorectal cancer:predictive role of lymph node metastasis and survival[J].Dis Colon Rectum,2014,109(8):848-852.
[18]WADA H,SHIOZAWA M,SUGANO N,et al.Lymphatic invasion identified with D2-40immunostaining as a risk factor of nodal metastasis in T1colorectal cancer[J].Int J Clin Oncol,2013,18(6):1025-1031.
[19]ISHIHARA S,KAWAI K.Oncological outcomes of lateral pelvic lymph node metastasis in rectal cancer treated with preoperative chemoradiotherapy[J].Dis Colon Rectum,2017,60:469-476.
[20]CHANG GJ,RODRIGUEZ-BIGAS MA,SKIBBER JM.Lymph node evaluation and survival after curative resection of colon cancer:systematic review[J].J Natl Cancer Inst,2007,99(6):433-441.
[21]PATEL HP,CHADWICK DR,HARRISON B.Systematic review of intravenous methylene blue in parathyroid surgery[J].Brit J Surg,2012,99(10):1345-1351.
[22]CAWTHORN SJ,GIBBS NM,MARKS CG.Clearance technique for the detection of lymph nodes in colorectal cancer[J].Brit J Surg,1986,73(1):58-60.
[23]QUADROS CA,LOPES A,ARAJO I.Retroperitoneal and lateral pelvic lymphadenectomy mapped by lymphoscintigraphy for rectal adenocarcinoma staging[J].Jpn J Clin Oncol,2010,40:746-753.
[24]GIPPONI M,DI SOMMA C.Sentinel lymph node biopsy in patients with stageⅠ/Ⅱmelanoma:clinical experience and literature review[J].J Surg Oncol,2004(85):133-140.
[25]DU JZ,ZHANG YS,JIA M,et al.Evaluation of the tracing effect of carbon nanoparticle and carbon nanoparticleepirubicin suspension in axillary lymph node dissection for breast cancer treatment[J].World J Surg Oncol,2016,14(1):164.
[26]FAN L,STRASSER-WEIPPL K,LI JJ,et al.Breast cancer in China[J].Lancet Oncol,2014,15(7):e279-289.
[27]YU WB,CAO XL,XU GH,et al.Potential role for Carbon nanoparticles to guide central neck dissection in patients with papillary thyroid cancer[J].Surgery,2016,160(3):755-761.
[28]RODRIGUEZ-BIGAS MA,MAAMOUN S,WEBER TK,et al.Clinical significance of colorectal cancer:metastases in lymph nodes<5mm in size[J].Ann Surg Oncol,1996,3(2):124-130.
[29]YANG Q,WANG XD,CHEN J,et al.A clinical study on regional lymphatic chemotherapy using an activated Carbon nanoparticleepirubicin in patients with breast cancer[J].Tumor Biology,2012,33(6):2341-2348.
[2]李道娟,李倩,贺宇彤.结直肠癌流行病学趋势[J].肿瘤防治研究,2015,42(3):305-310.
[3] KOTAKE K,HONJO S,SUGIHARA K,et al.Number of lymph nodes retrieved is an important determinant of survival of patients with stageⅡand stageⅢcolorectal cancer[J].Jpn J Clin Oncol,2012,42:29-35.
[4] TSAI HL,CHENG KI,LU CY,et al.Prognostic significance of depth of invasion,vascular invasion and numbers of lymph node retrievals in combination for patients with stageⅡcolorectal cancer undergoing radical resection[J].J Surg Oncol,2008,97(5):383-387.
[5] DILLMAN RO,AARON K,HEINEMANN FS,et al.Identification of 12or more lymph nodes in resected colon cancer specimens as an indicator of quality performance[J].Cancer,2009,115(9):1840-1848.
[6] BENSON 3RD AB,VENOOK AP,BEKAII-SAAB T,et al.Colon cancer,version 3[J].J Natl Compr Canc Netw,2014,12:1028-1059.
[7] EDGE SB,COMPTON CC.The American joint committee on cancer:the 7th edition of the AJCC cancer staging manual and the future of TNM[J].Ann Surg Oncol,2010,17(6):1471-1474.
[8]邱成志,吴友谊,王春晓.结直肠癌病检淋巴结数目与TNM分期及预后的关系[J].中华普通外科杂志,2011,26(6):493-495.
[9] XU XF,GU J.The application of Carbon nanoparticles in the lymph node biopsy of cN0papillary thyroid carcinoma:a randomized controlled clinical trial[J].Asian J Surg,2017,40(5):345-349.
[10]ZHANG L.Characteristics of activated carbon nanoparticles and its application in treatment of gastric cancer[J].J Int Oncol,2007,34(1):52-55.
[11]GE J,YAN B,CAO XC.Comparison of sentinel lymph node detection by methylene blue and carbon nanoparticle suspension injection in early breast cancer[J].Chin J Oncol,2011,33:226-228.
[12]CAI HK,HE HF,TIAN W,et al.Colorectal cancer lymph node staining by activated Carbon nanoparticles suspension in vivo or methylene blue in vitro[J].World J Gastroenterol,2012,18(42):6148-6154.
[13]SIEGEL RL,MILLER KD,FEDEWA SA,et al.Colorectal cancer statistics,2017[J].CA Cancer J Clin,2017,67(3):177-193.
[14]SIEGEL R,WARD E,BRAWLEY O,et al.Cancer statistics,2011:the impact of eliminating socioeconomic and racial disparities on premature cancer deaths[J].CA Cancer J Clin,2011,61(4):212-236.
[15]IMAI H,SAWADA K.Complete resection of liver metastases of colorectal cancer after high efficacy bevacizumab,S-1,and CPT-11combination chemotherapy[J].Gan To Kagaku Ryoho,2015,42:101-104.
[16]OKUGAWA Y,INOUE Y,TANAKA K,et al.Loss of the metastasis suppressor gene KiSS1is associated with lymph node metastasis and poor prognosis in human colorectal cancer[J].Oncol Rep,2013,30(3):1449-1454.
[17]HUH J,KIM H,PARK Y,et al.Mismatch repair system and p53expression in patients with T1and T2colorectal cancer:predictive role of lymph node metastasis and survival[J].Dis Colon Rectum,2014,109(8):848-852.
[18]WADA H,SHIOZAWA M,SUGANO N,et al.Lymphatic invasion identified with D2-40immunostaining as a risk factor of nodal metastasis in T1colorectal cancer[J].Int J Clin Oncol,2013,18(6):1025-1031.
[19]ISHIHARA S,KAWAI K.Oncological outcomes of lateral pelvic lymph node metastasis in rectal cancer treated with preoperative chemoradiotherapy[J].Dis Colon Rectum,2017,60:469-476.
[20]CHANG GJ,RODRIGUEZ-BIGAS MA,SKIBBER JM.Lymph node evaluation and survival after curative resection of colon cancer:systematic review[J].J Natl Cancer Inst,2007,99(6):433-441.
[21]PATEL HP,CHADWICK DR,HARRISON B.Systematic review of intravenous methylene blue in parathyroid surgery[J].Brit J Surg,2012,99(10):1345-1351.
[22]CAWTHORN SJ,GIBBS NM,MARKS CG.Clearance technique for the detection of lymph nodes in colorectal cancer[J].Brit J Surg,1986,73(1):58-60.
[23]QUADROS CA,LOPES A,ARAJO I.Retroperitoneal and lateral pelvic lymphadenectomy mapped by lymphoscintigraphy for rectal adenocarcinoma staging[J].Jpn J Clin Oncol,2010,40:746-753.
[24]GIPPONI M,DI SOMMA C.Sentinel lymph node biopsy in patients with stageⅠ/Ⅱmelanoma:clinical experience and literature review[J].J Surg Oncol,2004(85):133-140.
[25]DU JZ,ZHANG YS,JIA M,et al.Evaluation of the tracing effect of carbon nanoparticle and carbon nanoparticleepirubicin suspension in axillary lymph node dissection for breast cancer treatment[J].World J Surg Oncol,2016,14(1):164.
[26]FAN L,STRASSER-WEIPPL K,LI JJ,et al.Breast cancer in China[J].Lancet Oncol,2014,15(7):e279-289.
[27]YU WB,CAO XL,XU GH,et al.Potential role for Carbon nanoparticles to guide central neck dissection in patients with papillary thyroid cancer[J].Surgery,2016,160(3):755-761.
[28]RODRIGUEZ-BIGAS MA,MAAMOUN S,WEBER TK,et al.Clinical significance of colorectal cancer:metastases in lymph nodes<5mm in size[J].Ann Surg Oncol,1996,3(2):124-130.
[29]YANG Q,WANG XD,CHEN J,et al.A clinical study on regional lymphatic chemotherapy using an activated Carbon nanoparticleepirubicin in patients with breast cancer[J].Tumor Biology,2012,33(6):2341-2348.