淋巴示踪剂在腹腔镜胃癌根治术中的临床应用研究
|
摘要
目的:应用纳米活性炭注射在胃癌周边组织对淋巴结进行染色、示踪,从而在胃癌根治术中系统地清扫第二站淋巴结,探讨腹腔镜胃癌根治术中清扫淋巴结的方法及其效果。
方法:将2008年2月～2009年3月间在我科住院的40例进展期胃癌患者分成两组,一组接受腹腔镜胃癌D2根治术(腹腔镜组),另外一组接受开腹D2胃癌根治术(开腹组),两组患者均于术中在距肿瘤周边约5-8mm处胃壁浆肌层内分六点注射纳米活性炭1ml(50mg),对胃周引流淋巴结进行示踪,比较两组手术中清扫出的淋巴结个数和黑染淋巴结个数、黑染度。
结果:两组手术中胃周引流淋巴结能黑染,对淋巴结清扫起指引作用。腹腔镜组的黑染淋巴结个数、黑染度(%)为17.8±5.7、65.6±4.5,开腹组的黑染淋巴结个数、黑染度(%)为17.0±5.0、65.3±4.4,两组比较P＞0.05,无统计学差异;腹腔镜组和开腹组术中清扫出的淋巴结个数分别为27.7±9.1,26.0±7.6。两组比较P＞0.05,差别无显著性意义。
结论:在腹腔镜胃癌根治术中,纳米活性炭仍能使胃周引流淋巴结黑染,对淋巴结的清扫起指引作用,其效果与开腹手术相同。腹腔镜胃癌D2根治术治疗进展期胃癌,能达到与开腹手术相同的淋巴结清扫效果。
Object:To study the way and effect of lymphonode scavenge in laparoscopic radical gastrectomy,by injecting carbon nanoparticles suspension to dye and trace the lymphonode around stomach tumor.
Methods:40 patients with progressive gastric cancer who received operation in our deparment were chosed between Feb 2008 and March 2009.They were randomly divided into two groups.Group one received traditional gastric cancer D2 radical operation(G1).Group 2 adopted laparoscopic radical gastrectomy(G2).Both groups were injected carbon nanoparticles around tumor in 6 points during the opertaion to trace the lymphonode drain.Then we compared the lymphonode numbers scavenged during operation and metastatic lymphonode numbers,metastatic rate.
Result:Lymphonodes draining around stomach can be dyed in both operation,which has guide role for lymphonode scavenge.The metastatic lymphonode number and metastatic rate(%) of G1 and G2 was 17.0±5.0、65.34±4.4 and 17.8±5.7、65.6±4.5 (P＞0.05,no significance).The lymphonode number scavenged in operation for G1 and G2 was 26.0±7.6 and 27.7±9.1(P＞0.05,no significance).
Conclusions:Carbon nanoparticles suspension injection can dye and trace the lymphonode drain around stomach,which has guide role in laparoscopic radical gastrectomy.Laparoscopic radical gastrectomy has the same lymphonode-scaveneged efficacy as traditional gastric cancer D2 radical operation for progressive gastric cancer,scilicet the same recent radical effect.
方法:将2008年2月～2009年3月间在我科住院的40例进展期胃癌患者分成两组,一组接受腹腔镜胃癌D2根治术(腹腔镜组),另外一组接受开腹D2胃癌根治术(开腹组),两组患者均于术中在距肿瘤周边约5-8mm处胃壁浆肌层内分六点注射纳米活性炭1ml(50mg),对胃周引流淋巴结进行示踪,比较两组手术中清扫出的淋巴结个数和黑染淋巴结个数、黑染度。
结果:两组手术中胃周引流淋巴结能黑染,对淋巴结清扫起指引作用。腹腔镜组的黑染淋巴结个数、黑染度(%)为17.8±5.7、65.6±4.5,开腹组的黑染淋巴结个数、黑染度(%)为17.0±5.0、65.3±4.4,两组比较P＞0.05,无统计学差异;腹腔镜组和开腹组术中清扫出的淋巴结个数分别为27.7±9.1,26.0±7.6。两组比较P＞0.05,差别无显著性意义。
结论:在腹腔镜胃癌根治术中,纳米活性炭仍能使胃周引流淋巴结黑染,对淋巴结的清扫起指引作用,其效果与开腹手术相同。腹腔镜胃癌D2根治术治疗进展期胃癌,能达到与开腹手术相同的淋巴结清扫效果。
Object:To study the way and effect of lymphonode scavenge in laparoscopic radical gastrectomy,by injecting carbon nanoparticles suspension to dye and trace the lymphonode around stomach tumor.
Methods:40 patients with progressive gastric cancer who received operation in our deparment were chosed between Feb 2008 and March 2009.They were randomly divided into two groups.Group one received traditional gastric cancer D2 radical operation(G1).Group 2 adopted laparoscopic radical gastrectomy(G2).Both groups were injected carbon nanoparticles around tumor in 6 points during the opertaion to trace the lymphonode drain.Then we compared the lymphonode numbers scavenged during operation and metastatic lymphonode numbers,metastatic rate.
Result:Lymphonodes draining around stomach can be dyed in both operation,which has guide role for lymphonode scavenge.The metastatic lymphonode number and metastatic rate(%) of G1 and G2 was 17.0±5.0、65.34±4.4 and 17.8±5.7、65.6±4.5 (P＞0.05,no significance).The lymphonode number scavenged in operation for G1 and G2 was 26.0±7.6 and 27.7±9.1(P＞0.05,no significance).
Conclusions:Carbon nanoparticles suspension injection can dye and trace the lymphonode drain around stomach,which has guide role in laparoscopic radical gastrectomy.Laparoscopic radical gastrectomy has the same lymphonode-scaveneged efficacy as traditional gastric cancer D2 radical operation for progressive gastric cancer,scilicet the same recent radical effect.
引文
1 Goh P,Tekant Y.Kum CK.et al.Totally intra—abdominal laparoscopic Billroth Ⅱ gastrectomy.Surg Endosc,1992,6:160.
2 Kitano S,Iso Y,Moriyama M,et al Laparoscopic—assiste Billroth Ⅰ gastrectomy.Surg Laparosc Endosc,1994,4:146～148.
3 Goh P M?Khan A Z,So J B,et al.Early experience with laparoscopic radical gastrectomy for advance gastric cancer[J].Surg Laparosc Endosc Percuta Tech,2001,11:83～87.
4 Japan Society for Endoscopic Surgery.Nationwide survey On endoscopic surgery in Japan.J Jpn Soc Endosc Surg,2004.9:475～569.
5 Ohashi S.Laparoscopic intraluminal (intragastric)surgery for early gastric cancer[J].Surg Endosc,1995,9(2):169～171.
6 OhgamiM,OtaniY,KumaiK,etal.Curative laparoseopic sugery for early gastric cancer:five years experience[J].World J Surg,1999,23(2):187～192.
7 Shim CS.Endoscopic mucosal resection.3 rd International Gastric Cancer Congress,Seoul,1999,Abstracts:49.
8 Ohgami M,Otani Y,Kumai K,et al.Curative laparoscopic surgery for early gastric cancer:Five years experience.World J Surg,1999,23:187～193.
9 Folli S,Morgagni P,Roviello F,et al.Risk factors for lymph node metastases and their prognostic significance in early gastric cancer (EGC)for the Italian Research Group for Gastric Cancer(IRGGC).Jpn J Clin Oncol,2001,31:495～499.
10 Murray F.Curent status of surgery for gastric cancer:a review.Gastric Cancer.2005.8:64～70.
11 Kitano S,shiraishi N.Mimimally invasive surgery for gastric tumors[J].Surg Clin Noth.Am,2005,85(1):151～164.
12 Kitano S,Shiraishi N,Current status of laparoseopic gastrectomy for cancer in Japan[J].Surg-Endosc,2004,18(2):182～185.
13 Kim YW.Han H.Fleischer GD.et al.Hand—assisted laparoscopic total gastrectomy.Surg Laparosc Endosc Pemutan Tech.2003,13:26-30.
14 刘文韬,译.2002年版日本胃癌治疗规范.中华胃肠外科杂志,2003.6:131-132.
15 王舒宝.胃癌37年临床研究的结果分析--附2326例报告.中国肿瘤临床,1999,26:325-329.
16 陈凛.腹腔镜在胃癌手术中的应用[J].中华胃肠外科杂志,2004,7(3):170.
17 余佩武,王自强,张超,等.腹腔镜辅助下根治性胃切除术17例临床初步报告.第三军医大学学报,2004,26:1869-1871.
18 余佩武,王自强,张超,等.腹腔镜辅助下根治性胃切除术23例临床初步报告.外科理论与实践,2004,9:461-463.
19 余佩武,王自强,钱峰.腹腔镜辅助下胃癌根治术71例临床报告[J].中华胃肠外科杂志,2005,9(5):401-03.
20 Goh PM,Khan AZ,Jimmy BY,et al.Early experience with laparascopic radical gastrectomy for advanced gastric cancer,Laparosc Endosc Pereutan Tech,2001,11:83-87.
21 Huscher CG Mingoli A,Sgarzini G,et al.Laparoscopy versus open subtotal gastrectomy for distal gastric cance.Ann Surg,1995,82:295-298.
22 Uyama I,Sugioka A,Fujita J,et al.Laparoscopic total gastrectomy with distal pancreato-Splenectomy and D2 lymphadenectomy for advanced gastric cancer.Gastric Cancer,1999,2:230-234.
23 Choi YB.Laparosepic gatrojejunostomy for palliation of gastric outlet obstruction in un- resectable gastric cancer[J].Surg-Endosc,2002,16(11):1620-1626.
24 Hagiwara A,Takahashi T,Sawai K,et al.Lymph nodal vital staining with newer carbon particle suspensions compared with india ink:experimental and clinical observations.Lymphology,1992,25(2):84-89.
25 Okamoto K,Sawai K,Minato H,et al.Number and anatomical extent of lymph nodemetastases in gastric cancer:analysis using intra-lymph node injection of activated carbon particles(CH40).Jpn J Clin oncol,1999,29(2):74-77.
26 郑春雷,许军.国产纳米活性炭在胃癌根治术中的应用.齐齐哈尔医学院学报.2008,29(3):275-277.
27 黄广建,陈忠清,刘懿,等.活性炭纳米粒对胃癌淋巴清扫的指导作用.中国现代医学杂志.2005,15(2):233-235.
28 刘文韬.2002年版日本胃癌治疗规范.中华胃肠外科杂志,2003,6(2):131.
29 余佩武,罗华星.腹腔镜下胃癌根治术的现状与前景.中国普外基础与临床杂志,2007,14(5):506-509.
30 Dulucq JL,Wintringer P,Stabilini C,et al.Laparoscop ic and open gastric resections form alignant lesions:a p rospective comparative study[J].Surg Endosc,2005,19(7):933-938.
31 Bianco A,Kostarelos K,Prato M.Applications of Carbon nanotubes in drug delivery.Curr Opin Chem Biol,2005,9(6):674-679.
32 Okamoto K,Sawai K,Minato H,et al.Number and anatomical extent of lymph node metastasis in gastric cancer:analysis using intra-lymph node injection of activated carbon particles(CH40)[J].JPN J Clin Oncol,1999,29(2),74-77.
33 Kobayashi H,Kawamoto S,Bernardo M,et al.Delivery of gadolinium-labeled nanoparticles to the sentinel lymph node:comparison of the sentinel node visualization and estimations of intra-nodal gadolinium concentration by the magnetic resonance imaging.J Control Release,2006,111(3):343-351.
34 龙跃平,王继亮.腹腔镜胃癌根治术的相关问题.医学新知杂志,2008,18(2):65-67.
2 Kitano S,Iso Y,Moriyama M,et al Laparoscopic—assiste Billroth Ⅰ gastrectomy.Surg Laparosc Endosc,1994,4:146～148.
3 Goh P M?Khan A Z,So J B,et al.Early experience with laparoscopic radical gastrectomy for advance gastric cancer[J].Surg Laparosc Endosc Percuta Tech,2001,11:83～87.
4 Japan Society for Endoscopic Surgery.Nationwide survey On endoscopic surgery in Japan.J Jpn Soc Endosc Surg,2004.9:475～569.
5 Ohashi S.Laparoscopic intraluminal (intragastric)surgery for early gastric cancer[J].Surg Endosc,1995,9(2):169～171.
6 OhgamiM,OtaniY,KumaiK,etal.Curative laparoseopic sugery for early gastric cancer:five years experience[J].World J Surg,1999,23(2):187～192.
7 Shim CS.Endoscopic mucosal resection.3 rd International Gastric Cancer Congress,Seoul,1999,Abstracts:49.
8 Ohgami M,Otani Y,Kumai K,et al.Curative laparoscopic surgery for early gastric cancer:Five years experience.World J Surg,1999,23:187～193.
9 Folli S,Morgagni P,Roviello F,et al.Risk factors for lymph node metastases and their prognostic significance in early gastric cancer (EGC)for the Italian Research Group for Gastric Cancer(IRGGC).Jpn J Clin Oncol,2001,31:495～499.
10 Murray F.Curent status of surgery for gastric cancer:a review.Gastric Cancer.2005.8:64～70.
11 Kitano S,shiraishi N.Mimimally invasive surgery for gastric tumors[J].Surg Clin Noth.Am,2005,85(1):151～164.
12 Kitano S,Shiraishi N,Current status of laparoseopic gastrectomy for cancer in Japan[J].Surg-Endosc,2004,18(2):182～185.
13 Kim YW.Han H.Fleischer GD.et al.Hand—assisted laparoscopic total gastrectomy.Surg Laparosc Endosc Pemutan Tech.2003,13:26-30.
14 刘文韬,译.2002年版日本胃癌治疗规范.中华胃肠外科杂志,2003.6:131-132.
15 王舒宝.胃癌37年临床研究的结果分析--附2326例报告.中国肿瘤临床,1999,26:325-329.
16 陈凛.腹腔镜在胃癌手术中的应用[J].中华胃肠外科杂志,2004,7(3):170.
17 余佩武,王自强,张超,等.腹腔镜辅助下根治性胃切除术17例临床初步报告.第三军医大学学报,2004,26:1869-1871.
18 余佩武,王自强,张超,等.腹腔镜辅助下根治性胃切除术23例临床初步报告.外科理论与实践,2004,9:461-463.
19 余佩武,王自强,钱峰.腹腔镜辅助下胃癌根治术71例临床报告[J].中华胃肠外科杂志,2005,9(5):401-03.
20 Goh PM,Khan AZ,Jimmy BY,et al.Early experience with laparascopic radical gastrectomy for advanced gastric cancer,Laparosc Endosc Pereutan Tech,2001,11:83-87.
21 Huscher CG Mingoli A,Sgarzini G,et al.Laparoscopy versus open subtotal gastrectomy for distal gastric cance.Ann Surg,1995,82:295-298.
22 Uyama I,Sugioka A,Fujita J,et al.Laparoscopic total gastrectomy with distal pancreato-Splenectomy and D2 lymphadenectomy for advanced gastric cancer.Gastric Cancer,1999,2:230-234.
23 Choi YB.Laparosepic gatrojejunostomy for palliation of gastric outlet obstruction in un- resectable gastric cancer[J].Surg-Endosc,2002,16(11):1620-1626.
24 Hagiwara A,Takahashi T,Sawai K,et al.Lymph nodal vital staining with newer carbon particle suspensions compared with india ink:experimental and clinical observations.Lymphology,1992,25(2):84-89.
25 Okamoto K,Sawai K,Minato H,et al.Number and anatomical extent of lymph nodemetastases in gastric cancer:analysis using intra-lymph node injection of activated carbon particles(CH40).Jpn J Clin oncol,1999,29(2):74-77.
26 郑春雷,许军.国产纳米活性炭在胃癌根治术中的应用.齐齐哈尔医学院学报.2008,29(3):275-277.
27 黄广建,陈忠清,刘懿,等.活性炭纳米粒对胃癌淋巴清扫的指导作用.中国现代医学杂志.2005,15(2):233-235.
28 刘文韬.2002年版日本胃癌治疗规范.中华胃肠外科杂志,2003,6(2):131.
29 余佩武,罗华星.腹腔镜下胃癌根治术的现状与前景.中国普外基础与临床杂志,2007,14(5):506-509.
30 Dulucq JL,Wintringer P,Stabilini C,et al.Laparoscop ic and open gastric resections form alignant lesions:a p rospective comparative study[J].Surg Endosc,2005,19(7):933-938.
31 Bianco A,Kostarelos K,Prato M.Applications of Carbon nanotubes in drug delivery.Curr Opin Chem Biol,2005,9(6):674-679.
32 Okamoto K,Sawai K,Minato H,et al.Number and anatomical extent of lymph node metastasis in gastric cancer:analysis using intra-lymph node injection of activated carbon particles(CH40)[J].JPN J Clin Oncol,1999,29(2),74-77.
33 Kobayashi H,Kawamoto S,Bernardo M,et al.Delivery of gadolinium-labeled nanoparticles to the sentinel lymph node:comparison of the sentinel node visualization and estimations of intra-nodal gadolinium concentration by the magnetic resonance imaging.J Control Release,2006,111(3):343-351.
34 龙跃平,王继亮.腹腔镜胃癌根治术的相关问题.医学新知杂志,2008,18(2):65-67.