微创医学

目的探讨纳米碳示踪剂在肠镜结直肠癌根治术中的临床意义。方法将62例结直肠癌患者随机分为观察组和对照组各31例。对照组被确诊后直接行结直肠癌根治术。观察组在术前1天接受肠镜下多点黏膜下注射纳米碳示踪剂，次日接受结直肠癌根治术，术中以纳米碳黑染淋巴结为指导扩大淋巴结清扫范围。以术后淋巴结病理检查为金标准，评价纳米碳示踪剂黑染淋巴结预测阳性淋巴结的准确性及对阳性淋巴结检出率的影响。结果对照组共检出淋巴结750枚，经病理证实淋巴结阳性患者12例，阳性淋巴结61枚，总检出率8.13%（61/750）。观察组共检出淋巴结869枚，淋巴结阳性患者17例，阳性淋巴结96枚，总检出率为11.05%（96/869）。两组阳性淋巴结检出率比较，差异有统计学意义(P＜0.05)。其中96枚病检阳性淋巴结中被纳米碳黑染的有48枚，黑染率为50.0%（48/96）。纳米碳示踪剂标记黑染淋巴结预测淋巴结阳性患者的灵敏度为64.7%，特异度为85.7%，准确度为74.2%。结论术前纳米碳示踪剂标记结直肠癌前哨淋巴结对术中淋巴结清扫具有指导意义，能提高结直肠癌根治术的淋巴结清扫数量以及转移淋巴结的检出率。

ObjectiveTo explore the clinical significance of nano-carbon lymph tracer in curative colonoscopic resection for colorectal carcinomo. MethodsSixty-two patients with colorectal carcinoma were randomly divided into observation group and control group, 31 cases in each group. Patients in the control group were treated with curative colonoscopic resection for colorectal carcinomo.One day before operation, patients in the observation group were given mucosa multi-points injection of carbon nano-carbon tracer under colonoscopy, and then were underwent curative colonoscopic resection for colorectal carcinomo in the second day; the extent of lymph node dissection was enlarged according to the nano-carbon black stained lymph nodes. Postoperative lymph node biopsy were used as the gold standard, to evaluate the accuracy of nano-carbon tracer labeled black stained lymph node in predicting the positive lymph nodes, as well as the effect on the detection rate of positive lymph nodes. ResultsA total of 750 lymph nodes were detected in control group, pathologically confirmed 12 cases of lymph node positive patients, 61 positive lymph nodes; the total detection rate was 8.13%(61/750). A total of 869 lymph nodes were detected in observation group, 17 cases of lymph node positive patients, 96 positive lymph nodes; the total detection rate was 11.05%(96/869). Comparing the detection rate of positive lymph node in the two groups, the difference was statistically significant (P＜0.05). Among the 96 pathological positive lymph nodes, 48 lymph nodes were black stained by nano-carbon tracer, the black stained rate was 50.0%(48/96). Nano-carbon tracer black stained lymph nodes in predicting the lymph node positive patients, the sensitivity was 64.7%, specificity 85.7%, accuracy 74.2%. ConclusionsPreoperative nano-carbon tracer for sentinel lymph node dissection in colorectal carcinoma has a guiding significance in intraoperative lymph node dissection, which can improve the number of lymph node dissection and the detection rate of lymph node metastasis.