【摘要】 目的探讨纳米炭淋巴示踪剂对局部进展期胃癌术前化疗(NCT)联合手术治疗后检获淋巴结的影响。方法选取2014年1月—2015年1月河北医科大学第四医院外三科收治的局部进展期胃癌患者76例为研究对象,其均接受NCT后进行手术。采用随机数字表法将患者分为纳米炭组和对照组,各38例。纳米炭组在术前给予淋巴结示踪剂。比较两组淋巴结检获情况、淋巴结转移率、淋巴结黑染率及淋巴结病理分期(pN)情况。结果纳米炭组共检获淋巴结1 328枚,平均(35.2±8.3)枚/人;对照组共检获淋巴结945枚,平均(24.6±6.8)枚/人,纳米炭组淋巴结检获量高于对照组,差异有统计学意义(t=7.45,P<0.05)。纳米炭组长径<5 mm的淋巴结检获率为62.5%(830/1 328),高于对照组的42.1%(398/945),差异有统计学意义(χ~2=92.30,P<0.05)。纳米炭组转移淋巴结检出率为13.7%(182/1 328),高于对照组的10.2%(96/945),差异有统计学意义(χ~2=6.46,P<0.05)。纳米炭组黑染淋巴结914枚,黑染率为68.8%(914/1 328);黑染淋巴结中转移淋巴结检出率为17.9%(164/914);未黑染淋巴结中转移淋巴结检出率为4.3%(18/414);黑染淋巴结的转移淋巴结检出率高于对照组及未黑染淋巴结,差异均有统计学意义(χ~2=23.40、44.53,P<0.05)。纳米炭组pN0为3例(7.9%)、pN1为19例(50.0%)、pN2+pN3为16例(42.1%),对照组pN0为12例(31.6%)、pN1为16例(42.1%)、pN2+pN3为10例(26.3%),两组pN比较,差异有统计学意义(χ~2=7.04,P<0.05)。两组患者均未出现明显毒副作用及手术相关并发症。结论纳米炭淋巴示踪剂能提高阳性淋巴结及小淋巴结检出率,有助于提高局部进展期胃癌NCT后精确的pN分期,且安全性好。更多还原

【Abstract】 Objective To investigate the influence of nano carbon lymphatic tracer on the detection of lymph nodes after neoadjuvant chemotherapy( NCT) prior to locally advanced gastric cancer surgery. Methods We enrolled 76 patients with locally advanced gastric cancer who were admitted into the Third Department of Surgery of the Fourth Affiliated Hospital of Hebei Medical University from January 2014 to January 2015. All the patients underwent NCT prior to surgery. Random number table method was employed to divide patients into nano carbon group and control group,with 38 people in each group. Nano carbon group was given nano carbon lymphatic tracer prior to surgery. Comparison was made in lymph node’s detection,transport rate,black staining rate and pathological staging between the two groups. Results A total of 1 328 lymph nodes were detected in nano carbon group,with( 35. 2 ± 8. 3) in each patient averagely; a total of 945 lymph nodes were detected in control group,with( 24. 6 ± 6. 8) in each patient averagely. Nano carbon group was higher than control group in the detection amount of lymph nodes( t = 7. 45,P < 0. 05). The detection rate of lymph nodes with the maximum diameter < 5 mm was 62. 5%( 830 /1 328)in nano carbon group,higher than that of control group which was 42. 1%( 398 /945)( χ~2= 92. 30,P < 0. 05). The transport rate of lymph nodes was 13. 7%( 182 /1 328) in nano carbon group,higher than that of control group which was 10. 2%( 96 /945)( χ~2= 6. 46,P < 0. 05). Nano carbon group had 914 black staining lymph nodes,with a proportion of 68. 8%( 914/1 328); the detection rate of lymph node metastasis among black staining lymph nodes was 17. 9%( 164 /914); the detection rate of lymph node metastasis among non black staining lymph nodes was 4. 3%( 18 /414); the detection rate of lymph node metastasis among black staining lymph nodes was higher than control group and non black staining lymph nodes( χ~2= 23. 40,44. 53; P < 0. 05). In nano carbon group,the numbers of patients at pN0,pN1 and pN2 + pN3 were 3( 7. 9%),19( 50. 0%) and 16( 42. 1%); in control group,the numbers of patients at pN0,pN1 and pN2 + pN3 were 12( 31. 6%),16( 42. 1%) and 10( 26. 3%) respectively. The two groups were significantly different in pN( χ~2= 7. 04,P < 0. 05). No obvious toxic effect and relevant complications were observed in both groups. Conclusion Nano varbon lymphatic tracer could improve the detection rate of positive lymph nodes and small lymph nodes and promote accurate pN staging after neoadjuvant chemotherapy( NCT) for locally advanced gastric cancer with superior safety.更多还原