切换至 "中华医学电子期刊资源库"
高级检索
中华腔镜外科杂志(电子版)

中华腔镜外科杂志(电子版) ›› 2020, Vol. 13 ›› Issue (06): 352 -356. doi: 10.3877/cma.j.issn.1674-6899.2020.06.008

所属专题： 文献资源库；

论著 上一篇    下一篇

纳米炭导航3D腹腔镜胃癌根治术中淋巴结分拣的临床价值探讨
陆晓峰 1, 刘颂 2, 艾世超 2, 王行舟 1, 夏雪峰 2, 沈晓菲 2, 宋鹏 2, 康星 1, 王萌 2, 管文贤 3 , †( )   
  1. 1. 210008 南京医科大学鼓楼临床医学院胃肠外科
    2. 210008 南京大学医学院附属鼓楼医院胃肠外科
    3. 210008 南京医科大学鼓楼临床医学院胃肠外科；210008 南京大学医学院附属鼓楼医院胃肠外科
  • 收稿日期:2020-09-03 出版日期:2020-12-30
  • 通信作者: 管文贤
  • 基金资助:
    国家自然科学基金(81602103，81970500); 南京市医学科技发展杰出青年基金(JQX17005，JQX19001); 吴阶平医学基金会卓越外科培育计划(320.2710.1817)

Lymph node examination in carbon nanoparticles-guided lymph node dissection during 3D laparoscopic radical gastrectomy

Xiaofeng Lu 1, Song Liu 2, Shichao Ai 2, Xingzhou Wang 1, Xuefeng Xia 2, Xiaofei Shen 2, Peng Song 2, Xing Kang 1, Meng Wang 2, Wenxian Guan 3 , †( )   

  1. 1. Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, the Clinical College of Nanjing Medical University, Nanjing 210008, China.
    2. Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
    3. Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, the Clinical College of Nanjing Medical University, Nanjing 210008, China; Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
  • Received:2020-09-03 Published:2020-12-30
  • Corresponding author: Wenxian Guan
全文 ( ) 下载PDF ( )
目的

探讨淋巴结分拣是否有助于提高纳米炭导航3D腹腔镜胃癌根治术后淋巴结分拣数目。

方法

入选患者随机化分为淋巴结未分拣组与分拣组，进一步根据病理分期及胃癌根治术式实施亚组分析，比较组间淋巴结清扫数目，同时比较围手术期安全性与随访存活率。

结果

共纳入147例患者，其中淋巴结未分拣组58例、淋巴结分拣组89例，两组患者的基线特征一致。所有患者的平均手术时间(214.8±55.6)min，术中出血量(128.7±106.0)ml，术后并发症12例次(7.5%)，围手术期二次手术率1.3%，术后住院时间(11.5±3.7)d，平均随访时间(15.1±6.9)个月，两组均无死亡。两组患者的围手术期安全性差异无统计学意义。淋巴结分拣能够显著提高Ⅰ期胃癌的淋巴结清扫数目[(29.0±12.3)枚比(24.1±7.8)枚，P＝0.04]，也能够显著提高根治性全胃切除术中的淋巴结清扫数目[(31.3±11.2)枚比(25.1±7.6)枚，P＝0.02]。

结论

淋巴结分拣有助于提高纳米炭导航3D腹腔镜下Ⅰ期胃癌与根治性全胃切除术的淋巴结清扫数目。

关键词: 纳米炭, 腹腔镜胃癌根治术, 淋巴结分拣
Objective

To evaluate the effect of lymph node examination on the number of retrieved lymph nodes in carbon nanoparticles-guided 3D laparoscopic radical gastrectomy.

Methods

Qualified participants were randomized into non-examined or examined group. Sub-group analysis according to different pathological stage or type of radical gastrectomy were conducted. The number of retrieved lymph nodes were compared between groups. Perioperative safety and survival during follow-up period were compared as well.

Results

A total of 147 patients including 58 cases in non-examined group and the other 89 cases in examined group were collected. Baseline was similar between groups. The overall duration of operation was (214.8±55.6)min, intraoperative bleeding was (128.7±106.0)ml, postoperative complication rate was 7.5%, secondary operation rate was 1.3%, postoperative hospitalization was (11.5±3.7)d, and all were survival during (15.1±6.9) month follow-up period. The safety was similar between two groups. Lymph node examination can significantly improve the number of retrieved lymph nodes for stage Ⅰ gastric cancer (29.0±12.3) vs. (24.1±7.8), P=0.04) and total radical gastrectomy (31.3±11.2) vs.( 25.1±7.6), P=0.02).

Conclusions

Lymph node examination can improved the number of retrieved lymph nodes in stage I gastric cancer and total radical gastrectomy in carbon nanoparticles-guided 3D laparoscopic radical gastrectomy.

Key words: Carbon nanoparticles, Laparoscopic gastrectomy, Lymph node examination
表1 两组纳米炭导航3D腹腔镜胃癌根治术患者的临床与病理特征
组别 例数 男性[例(%)] 年龄(岁， ±s) 基础疾病(例) 病理分期(例) 胃癌根治术(例)
高血压 糖尿病 其他 Ⅰ Ⅱ Ⅲ 远端胃 全胃
淋巴结未分拣组 58 42(72.4) 59.8±9.9 20 4 11 34 10 14 36 22
淋巴结分拣组 89 57(64.0) 57.5±11.5 23 5 14 54 18 17 54 35
t值   - 1.25 - - 0.03
χ2值   1.12 - 2.44 0.61 -
P值   0.29 0.22 0.12 0.74 0.87
图1 纳米炭导航3D腹腔镜胃癌根治术中的淋巴结示踪
表2 两组纳米炭导航3D腹腔镜胃癌根治术患者的安全性指标
组别 例数 手术时间(min， ±s) 术中出血量(ml， ±s) 术后并发症(例) 并发症分级(例) 二次手术(例) 术后住院时间(d， ±s)
Ⅰ～Ⅱ级 ≥Ⅲ级
淋巴结未分拣组 58 207.3±51.1 115.0±130.8 3 3 0 0 10.5±2.3
淋巴结分拣组 89 219.7±58.1 137.6±85.7 9 7 2 2 12.1±4.3
t值   1.33 1.27 - - - 1.66
χ2值   - - 1.14 0.80 1.32 -
P值   0.19 0.21 0.28 0.37 0.25 0.09
表3 两组纳米炭导航3D腹腔镜胃癌根治术患者的淋巴结清扫数目(例， ±s)
组别 例数 病理分期 胃癌根治术
Ⅰ Ⅱ Ⅲ 远端胃切除术 全胃切除术
淋巴结未分拣组 58 24.1±7.8 29.7±11.3 28.6±7.0 26.8±9.1 25.1±7.6
淋巴结分拣组 89 29.0±12.3 34.0±10.8 33.6±11.1 30.7±12.4 31.3±11.2
t值   2.12 0.99 1.45 1.61 2.35
P值   0.04 0.33 0.16 0.11 0.02
1
Deng J, YamashⅠta H, Seto Y, et al. Ⅰncreasing the number of examined lymph nodes is a prerequisite for improvement in the accurate evaluation of overall survival of node-negative gastric cancer patients[J]. Annual of Surgical Oncology, 2017, 24(3): 745-753.
2
黄昌明，黄泽宁. 完全腹腔镜胃癌根治术后消化道重建的选择和操作要点[J/CD]. 中华腔镜外科杂志(电子版), 2019, 12(1): 34.36.
3
中华医学会外科学分会腹腔镜与内镜外科学组，中国医师协会外科医师分会微创外科医师委员会. 3D腹腔镜手术技术中国专家共识(2019版) [J]. 中国实用外科杂志，2019, 39(11): 1136-1141.
4
Li Z, Ao S, Bu Z, et al. Clinical study of harvesting lymph nodes with carbon nanoparticles in advanced gastric cancer: a prospective randomized trial[J]. World Journal of Surgical Oncology, 2016, 14(1): 88-88.
5
朱煜，陈新华，李婷婷，等. 胃癌D2淋巴结清扫术后标本淋巴结分拣的经验分享[J]. 中华胃肠外科杂志，2019, 22(8): 796-800.
6
胡祥，张驰. 第15版日本《胃癌处理规约》拔萃[J]. 中国实用外科杂志，2018, 38(5): 520-528.
7
中国抗癌协会胃癌专业委员会，中华医学会肿瘤学分会胃肠学组，中国医师协会外科医师分会肿瘤外科医师委员会. 胃癌根治术标本规范淋巴结送检及操作中国专家共识(2019版)[J]. 中国实用外科杂志，2019, 39(9): 881-889.
8
Clavien PA, Barkun J, Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience[J]. Annual of Surgery, 2009, 250(2): 187-196.
9
胡祥. 第5版日本《胃癌治疗指南》拔萃[J]．中国实用外科杂志，2018, 38(4): 396-406.
10
international Union Against Cancer (UICC). TNM classification of malignant tumors 8th ed[M]. New York: Wiley-Liss, 2017.
11
Deng JY, Liang H, Sun D, et al. Outcome in relation to numbers of nodes harvested in lymph node-positive gastric cancer[J]. European Journal of Surgical Oncology, 2009, 35(8): 814-819.
12
Smith DD, Schwarz RR, Schwarz RE, et al. Impact of total lymph node count on staging and survival after gastrectomy for gastric cancer: data from a large US-population database[J]. Journal of Clinical Oncology, 2005, 23(28): 7114-7124.
13
Sano T, Coit DG, Kim HH, et al. Proposal of a new stage grouping of gastric cancer for tnm classification: international gastric cancer association staging project[J]. Gastric Cancer, 2017, 20(2): 217-225.
14
Deng J, Liu J, Wang W, et al. Validation of clinical significance of examined lymph node count for accurate prognostic evaluation of gastric cancer for the eighth edition of the american joint committee on cancer (AJCC) tnm staging system[J]. Chinese Journal of Cancer Research, 2018, 30(5): 477-491.
15
张楠楠，邓靖宇，何文婷，等. 727例胃癌根治术标本淋巴结精细分拣的临床价值探讨[J]. 中国肿瘤临床，2019, 46(1): 22-27.
16
邓靖宇，梁寒. 胃癌根治术后规范淋巴结送检的要点及临床意义[J]. 中华胃肠外科杂志，2018, 21(10): 1183-1190.
17
Yan J, Zheng X, Liu Z, et al. A multicenter study of using carbon nanoparticles to show sentinel lymph nodes in early gastric cancer[J]. Surgical Endoscopy, 2016, 30(4): 1294-300.
18
洪强，汪勇，王建军，等. 术前胃镜下注射法纳米炭淋巴结示踪技术在腹腔镜胃癌根治术中的应用[J]. 中华医学杂志，2017, 97(2): 123-126.
19
Li Z, Ao S, Bu Z, et al. Clinical study of harvesting lymph nodes with carbon nanoparticles in advanced gastric cancer: a prospective randomized trial[J]. World Journal of Surgical Oncology, 2016, 14(1): 88-88.
[1] 陈天文, 温贺新, 刘牧林. 加速康复外科在老年腹腔镜胃癌根治术中的应用价值研究[J]. 中华普通外科学文献(电子版), 2021, 15(01): 47-51.
[2] 熊海波, 余松, 何雪铼, 侯能易, 王越, 付俊文, 张华, 许杰, 王康, 庞明辉. 纳米炭用于胃癌根治术中淋巴结示踪效果的Meta分析[J]. 中华普通外科学文献(电子版), 2021, 15(01): 75-80.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号