Objective: To evaluate the application value of carbon lymph node tracing technique by preoperative endoscopic subserosal injection in laparoscopic radical gastrectomy. Methods: From June 2013 to February 2015, seventy eight patients with gastric cancer were enrolled and randomly divided into trial group and control group. Subserosal injection of carbon nanoparticles around the tumor was performed by preoperative endoscopic subserosal injection one day before the operation in trial group, while the patients routinely underwent laparoscopic gastrectomy in control group. Results of harvested lymph nodes, postoperative complications were compared between the two groups. Carbon nanoparticle-related side effect was also evaluated. Results: The average number of harvested lymph node in trial group was significantly higher than that in control group (35.5±8.5 vs 29.5±6.5, P<0.05). The rate of overall black-dyed harvested lymph node was 74.7% (1 035/1 386) in trial group, the black-dyed lymph node rate in D1 lymph node was 80.1%, which was significantly higher than that in D2 lymph node (69.8%, χ2=19.38, P<0.01). When comparing the lymph node with and without black-dyed in trial group, the rate of metastasis lymph node was significantly higher in lymph node with black-dyed (17.3% vs 4.0%, χ2=38.67, P<0.01). There was no significant difference in postoperative complications rate between two group (trial group 10.2%; control group 12.8%, χ2=0.00, P>0.05), and no carbon nanoparticle-related side effect was observed. Conclusion: Given a higher harvested lymph node number and a similar rate of complications, preoperative endoscopic subserosal injection of carbon nanoparticles was safe and feasible.
目的 研究术前胃镜下注射法纳米碳淋巴示踪技术在腹腔镜胃癌根治术中的应用价值。 方法 选取2013年6月至2015年2月浙江金华广福医院收治的78例胃癌患者，随机分成实验组和对照组，每组39例，实验组术前经胃镜在肿瘤与正常胃黏膜交界处注射纳米碳进行胃周淋巴结示踪，两组患者均接受腹腔镜胃癌根治术治疗，对两组患者的淋巴结清扫结果进行比较，观察两组患者术后并发症及实验组药物不良反应。 结果 实验组患者每例清扫淋巴结(35.5±8.5)枚，明显高于对照组的(29.5±6.5), P<0.05。实验组淋巴结黑染率为74.7%(1 035/1 386)，其中第1站淋巴结黑染率为80.1%(524/654)，第2站淋巴结69.8%(511/732)，第1站淋巴结黑染率高于第2站，差异有统计学意义(χ2＝19.38，P<0.01)。实验组黑染与未黑染淋巴结转移率比较，黑染淋巴结转移率为17.3%(179/1 035)，未黑染淋巴结转移率为4.0%(14/351)，差异有统计学意义(χ2＝38.67，P<0.01)。两组术后并发症比率对比差异无统计学意义(实验组10.2%；对照组12.8%，χ2＝0.00，P>0.05)。未发现纳米碳相关不良反应。 结论 纳米碳淋巴示踪技术应用于腹腔镜胃癌根治术中是安全可行的，能有效提高淋巴结检出率。.