CAJ | 학술논문

目的：探讨纳米炭淋巴示踪剂在进展期胃癌根治术中的应用价值。方法选取2013年10月—2014年5月河北医科大学第四医院外三科进展期胃癌患者56例，采用随机数字表法将患者分为纳米炭组和对照组，各28例。患者均接受胃癌根治术 D2式全胃切除术，纳米炭组在手术过程中给予纳米炭示踪剂，对照组则不给予。标本离体后，寻找淋巴结，并记录检获淋巴结数目、直径和所需时间；纳米炭组记录淋巴结黑染，分组送病理检查，常规 HE 染色，显微镜观察淋巴结肿瘤转移情况。结果纳米炭组淋巴结检获（43.8±10.3）枚，高于对照组的（31.4±8.6）枚（t＝6.45，P ＝0.002）；检获所需时间（19.5±4.9）min 短于对照组的（31.7±5.3）min（t ＝4.52，P ＝0.013）。纳米炭组检获直径﹤5 mm 的淋巴结率为58.5％（422/721），高于对照组的37.9％（209/551）（χ2＝53.01，P ﹤0.05）；纳米炭组黑染检获最小淋巴结直径为（1.7±0.5）mm，小于对照组的（2.2±0.7）mm（t ＝3.16，P ﹤0.05）。纳米炭组检获淋巴结转移率为34.3％（247/721），高于对照组的17.4％（96/551）（χ2＝44.95，P ﹤0.05）。纳米炭组黑染率为84.9％（612/721），黑染淋巴结转移率为38.1％（233/612），高于未黑染淋巴结转移率12.8％（14/109）（χ2＝26.15，P ﹤0.05）。黑染淋巴结转移率亦高于对照组淋巴结转移率（χ2＝60.94，P ﹤0.05）。结论纳米炭淋巴示踪剂在进展期胃癌淋巴结清扫中可达到良好的淋巴结示踪效果，提高了淋巴结检出数目及小淋巴结检出数目。
목적：탐토납미탄림파시종제재진전기위암근치술중적응용개치。방법선취2013년10월—2014년5월하북의과대학제사의원외삼과진전기위암환자56례，채용수궤수자표법장환자분위납미탄조화대조조，각28례。환자균접수위암근치술 D2식전위절제술，납미탄조재수술과정중급여납미탄시종제，대조조칙불급여。표본리체후，심조림파결，병기록검획림파결수목、직경화소수시간；납미탄조기록림파결흑염，분조송병리검사，상규 HE 염색，현미경관찰림파결종류전이정황。결과납미탄조림파결검획（43.8±10.3）매，고우대조조적（31.4±8.6）매（t＝6.45，P ＝0.002）；검획소수시간（19.5±4.9）min 단우대조조적（31.7±5.3）min（t ＝4.52，P ＝0.013）。납미탄조검획직경﹤5 mm 적림파결솔위58.5％（422/721），고우대조조적37.9％（209/551）（χ2＝53.01，P ﹤0.05）；납미탄조흑염검획최소림파결직경위（1.7±0.5）mm，소우대조조적（2.2±0.7）mm（t ＝3.16，P ﹤0.05）。납미탄조검획림파결전이솔위34.3％（247/721），고우대조조적17.4％（96/551）（χ2＝44.95，P ﹤0.05）。납미탄조흑염솔위84.9％（612/721），흑염림파결전이솔위38.1％（233/612），고우미흑염림파결전이솔12.8％（14/109）（χ2＝26.15，P ﹤0.05）。흑염림파결전이솔역고우대조조림파결전이솔（χ2＝60.94，P ﹤0.05）。결론납미탄림파시종제재진전기위암림파결청소중가체도량호적림파결시종효과，제고료림파결검출수목급소림파결검출수목。
Objective To investigate the clinical value of carbon nanoparticle lymphatic tracer in lymph node dissection during radical resections for advanced gastric cancer. Methods 56 patients with advanced gastric cancer who were admitted to the Third Department of Surgery in the Fourth Hospital of Hebei Medical University from October 2013 to May 2014, were randomly divided into two groups(carbon nanoparticle group and control group) by random number table method,there were 28 cases in each group. All patients underwent gastrectomy with D2 lymphadenectomy,carbon nanoparticle lymphatic tracer was used in carbon nanoparticle group during operation,carbon nanoparticle lymphatic tracer was not used in control group during operation. The removal tissues were searched for lymph nodes,the number and diameter of lymph nodes,and the required time for lymph nodes detection were recorded. The dyed lymph nodes in carbon nanoparticle group were recorded. All lymph nodes were sent for pathology,and were stained by HE routinely,lymph node tumor metastasis was confirmed by microscope. Results The average number of positive lymph nodes in carbon nanoparticle group(43. 8 ± 10. 3) was significantly higher than that(31. 4 ± 8. 6)in control group( t = 6. 45,P = 0. 002). The mean required time for lymph nodes detection in carbon nanoparticle group(19. 5 ± 4. 9)min was significantly shorter than that(31. 7 ± 5. 3)min in control group(t = 4. 52,P = 0. 013). The proportion of positive small nodes( ﹤ 5 mm) in carbon nanoparticle group(58. 5% ,422 / 721) was significantly higher than that(37. 9% ,209 / 551)in control group(χ2 = 53. 01,P ﹤ 0. 05). The mean minimum diameter of positive small nodes in carbon nanoparticle group(1. 7 ± 0. 5)mm was significantly less than that(2. 2 ± 0. 7)mm in control group(t = 3. 16,P ﹤ 0. 05). The rate of lymph node metastasis in carbon nanoparticle group(34. 3% ,247 / 721)was significantly higher than that (17. 4% ,96 / 551)in control group(χ2 = 44. 95,P ﹤ 0. 05). The rate of black - dyed lymph nodes was 84. 9%(612 / 721) in carbon nanoparticle group. The metastasis rate of black - dyed lymph nodes(38. 1% ,233 / 612)was significantly higher than that(12. 8% ,14 / 109)of non - black - dyed lymph nodes(χ2 = 26. 15,P ﹤ 0. 05),and the metastasis rate of black - dyed lymph nodes in carbon nanoparticle group was significantly higher than the metastasis rate of lymph nodes in control group(χ2 =60. 94,P ﹤ 0. 05). Conclusion The application of carbon nanoparticle lymphatic tracer in lymph node dissection during radical resections for advanced gastric cancer can reach good effect,and can increase the number of positive lymph nodes,especially can increase the number of positive small nodes.