纳米碳标记在结直肠癌根治术中的应用_0

纳米碳标记在结直肠癌根治术中的应用（作者:___________单位: ___________邮编: ___________）

作者：傅骏郁宝铭卞国伟张敏陈利文

【摘要】目的探讨钠米碳淋巴结示踪剂在结直肠癌根治术中临床应用的意义。方法采用前瞻性病例对照研究，60例结直肠癌患者随机分为两组：30例患者于术前或术中先向癌灶周围注入钠米碳后再行根治术，30例对照组患者则不予注射纳米碳。分别记录检测黑染淋巴结与未黑染淋巴结数量及淋巴结转移情况。结果(1)钠米碳标记组平均每例清除12.6个淋巴结(6～18个)，淋巴结黑染率为51.9%。对照组平均每例清除8.1个淋巴结(4～14个)。标记组淋巴结检出数明显高于对照组(P=0.006 5)。(2)标记组黑染淋巴结癌肿侵犯阳性率33.6%，对照组淋巴结阳性率24.7%，标记组黑染淋巴结转移率高于对照组(P=0.014),同时标记组4 mm转移淋巴结检出率高于对照组(P=0.002 1)。(3)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，并相应扩大手术切除范围，术后病理证实淋巴结有癌转移。结论钠米碳淋巴结示踪剂染色效果良好，术中易识别，能指导手术医师术中正确制定手术方案进行淋巴结清除。

【关键词】结肠直肠肿瘤;淋巴转移;活性碳

[Abstract] Objective To explore the significance of clinical application of carbon nanoparticles labeled lymph node in curative resection for colorectal carcinoma. Methods With perspective research, 60 patients with colorectal carcinoma were randomized into two groups: carbon nanoparticles were injected into the periphery of the tumor in 30 patients before or during the operation, and 30 patients were as control without any injection during operation. The number of lymph nodes (dyed or not dyed) and the location of metastatic nodes were recorded separately. Results (1) In the labelling group, the average number of eliminated lymph nodes(12.6, 618)is significantly more than that of the control group(8.1, 414)(P=0.0065). The ratio of dyed lymph nodes was 51.9%. (2) The metastasis rate of dyed lymph nodes in labelling group was higher than that in the control group (33.6% vs. 24.7%, P=0.014), especially significant in 4mm nodes (P=0.0021). (3) During operation, two dyed lymph nodes in two cases were found at the root of inferior mesenteric artery and along the side of internal iliac artery, so the dissection was extended and the dyed lymph nodes were confirmed to be positive. Conclusion The technique of carbon nanoparticles labeled lymph nodes is easy and effective. The dyed lymph nodes can be easily identified and can

used as a guide for lymph nodes dissection in colorectal carcinoma operation.

[Key words] Colorectal neoplasms;Lymph node metastasis;Charcoal

结直肠癌是最常见的消化系统恶性肿瘤之一，首选是外科手术治疗。据报道在施行癌肿根治切除病例中，伴淋巴结转移者可高达45.3%[1]，而手术中尽量清除转移淋巴结对判断预后、指导术后辅助治疗和预防术后复发，提高生存率均具有重要意义。为了提高对转移淋巴结的切除率、避免遗漏，我们在术前和术中向癌灶周围注入纳米碳来标记结直肠癌引流淋巴结，并以此指导结直肠癌手术中淋巴结的清扫，通过60例结直肠癌手术资料的对比分析，以探讨它的临床应用价值。

1 临床资料与方法

1.1 一般资料从2005年6月至2006年8月我们将60例结直肠癌患者随机分为两组：纳米碳标记组30例，其中男17例，女13例;年龄38～79岁，平均5

2.4岁。其中升结肠癌4例,横结肠癌2例,降结肠癌8例,乙状结肠癌10例，直肠上段癌3例,腹膜返折下直肠癌3例。Dukes分期：A期4例，B期15例，C期10例，D期1例。术前在直肠镜下或术中在肿瘤周围肠壁内注入钠米碳。对照组30例则不予注射。两组患者在年龄、性别、及肿瘤部位之间无明显差异，所有患者均按根治术要求行癌肿切除术。

1.2 染色方法纳米碳由重庆莱美药业有限公司提供,每支1 mL