胃癌病灶周围注射超微活性炭对淋巴结的显色效果

目的观察胃癌病灶周围注射超微活性炭后局部淋巴结的黑染效果,指导胃癌手术淋巴结的清扫。方法43例胃癌患者术前或术中肿瘤周围注射超微活性炭,82例胃癌未接受注射者作为对照组,比较其清扫淋巴结的数目、黑染淋巴结数、淋巴结黑染与注射活性炭时间的关系、淋巴结转移情况,并观察副作用的发生。结果活性炭组每例患者清扫的淋巴结数(34枚±13枚)明显高于对照组(16枚±9枚),主要是清扫的N2淋巴结数明显最多(25枚±9枚∶8枚±4枚);活性炭组黑染度为603%,N1淋巴结的黑染度(713%)高于N2(563%);局部组织内注射超微活性炭,2d后淋巴结的黑染效果才较满意;黑染淋巴结中发生淋巴结转移的阳性率(268%)明显高于未黑染淋巴结(33%)及对照组(184%);局部组织注射超微活性炭未见严重副作用发生。结论肿瘤周围局部注射超微活性炭是一种有效、易行和安全的方法,对胃癌淋巴结清扫有指导作用。

Effect of injecting activated carbon ultramicroparticles around the gastric tumor on staining lymph node

OBJECTIVE: To observe the effect of injecting activated carbon ultramicroparticles around the gastric tumor before or during operation on staining lymph nodes and guiding the lymphadenectomy of gastric cancer. METHODS: Forty-three cases of gastric cancer received activated carbon (AC) ultramicroparticles around the tumor by submucosal endoscopic injection 1 approximately 6 days before the operation and/or intraoperative subserosal injection (AC group), whereas 82 cases of gastric cancer without the injection were used as control group. The number of dissected lymph nodes, number of black-stained lymph nodes and its relation to the injection time, metastasis of lymph nodes, and the side effect of the procedure were analyzed. RESULTS: The average numbers of resected lymph nodes were 34 +/- 13 in the AC group, significantly higher than that in the control group (16 +/- 9, P < 0.05). The dissected N(2) lymph nodes in the AC group was 25 +/- 9, significantly higher than that in the control group (8 +/- 4, P < 0.05). The total ratio of black-stained lymph node was 60.3% in general, 71.3% for the N1 lymph nodes and 56.3% for the N(2) lymph nodes in the AC group. Satisfactory effect of black staining of lymph nodes could be seen 2 days after local gastric tissue injection of activated carbon ultramicroparticles. The metastasis rate was 67.4% in the AC group, not significantly different from that in the control group (63.4%, P > 0.05). In the patients of AC group the metastasis rate of black-stained lymph node was 26.8%, significantly higher than that of the unstained lymph nodes (3.3%) and higher than that of the control group (18.4%). No serious side effect happened after the activated carbon ultramicroparticles injection in local gastric tissue. CONCLUSION: Local injection of activated carbon ultramicroparticles around the tumor is an effective, easy and safe procedure to guide gastric cancer lymphadenectomy.