纳米炭在腹腔镜下进展期直肠癌根治术中的应用

  目的  评价纳米炭在腹腔镜下进展期直肠癌根治术中的临床应用价值。  方法  选取2010年12月至2012年3月唐山市人民医院胃肠外科接受腹腔镜下直肠癌根治术治疗的80例患者，根据术中是否应用纳米炭分为试验组（40例）和对照组（40例），比较两组术中清扫淋巴结的总数，直径≤5 mm淋巴结数目及转移淋巴结数目，并观察有无药物不良反应。  结果  试验组注射纳米炭均未发生不良反应且术中黑染淋巴结清晰可辨；试验组患者清扫淋巴结总数（25.5±8.78）枚vs.（16.05±4.84）枚]，直径≤5 mm淋巴结枚数（22.6±8.25）枚vs.（13.65±4.62）枚]，转移淋巴结枚数（3.13±4.14）枚vs.（1.35±2.06）枚]均显著高于对照组（P<0.05）；其中2例直肠癌患者术中发现肠系膜下动脉根部及髂内动脉旁有黑染淋巴结，相应扩大手术切除范围，术后病理证实淋巴结有肿瘤细胞转移。  结论  在腹腔镜下直肠癌根治术中，应用纳米炭对直肠癌淋巴结清扫有指导作用，方法安全、有效。 

Application of carbon nanoparticle-labeled lymph nodes in laparo-scopic curative resection for advancing rectal cancer

  Objective  To evaluate the clinical value of activated carbon nanoparticles for guiding lymphadenectomy in advancing rectal cancer.  Methods  Eighty rectal cancer patients who underwent laparoscopic curative resection for rectal cancer were divided into two groups: control group (40 cases) and experiment group (40 cases). The experiment group received carbon nanoparticle-labeled lymph nodes in surgery. The number of lymph nodes, lymph nodes ≤5 mm in size, and positive lymph nodes, as well as the side effect of the procedure, were analyzed.  Results  No complications were observed in the experiment group. The experiment group showed significantly higher values (P<0.05) than the control group for average number of lymph nodes (25.5 ± 8.78 vs. 16.05 ± 4.84), lymph nodes ≤5mm in size (22.6±8.25 vs. 13.65±4.62), and positive lymph nodes (3.13±4.14 vs. 1.35±2.06). During operation, two dyed lymph nodes in two cases were found at the roof of the inferior mesenteric artery and along the side of the internal iliac artery. Dissection was extended for these patients and the dyed lymph nodes were confirmed to be positive.  Conclusion  Local injection of activated carbon nanoparticles around the tumor during surgical exploration was an effective, secure, and easy approach for guiding lymphadenectomy in rectal cancer patients.