摘要目的 探讨不同方法注射纳米碳淋巴示踪剂在胃癌根治术中的应用价值.方法 2014年1月至2015年12月在福州总医院行胃癌D2根治术的患者,按照随机数字表法随机分为A组和B组,A组于术前24 h在肿瘤周围黏膜下注射纳米碳混悬液,B组先行黏膜下生理盐水注射,待黏膜抬起后于原注射点注射纳米碳混悬液.操作过程由5位高年资医师和3位低年资医师完成.比较两组淋巴结检获情况、黑染情况、检出时间及转移率.结果 共纳入患者248例,A组和B组分别124例,两组患者一般资料比较差异无统计学意义(P>0.05).A组共检出淋巴结2975枚,B组检出3855枚,A组平均淋巴结检出数量少于B组[(23.9±7.9)枚比(31.1±3.6)枚,P=0.00].A组黑染淋巴结检出率为71.3%(2121/2975),低于B组的78.1%(3011/3855,P=0.00).两组淋巴结检出时间[(24.3±5.7)min比(23.5±6.2)min]、微小淋巴结检出率(33.1%比34.9%)、淋巴结转移率(27.3%比25.8%)比较差异无统计学意义(P>0.05).A组低年资医师组淋巴结检出数目[(16.9± 4.0)枚比(30.1±3.7)枚]、淋巴结黑染率(61.3%比77.2%)均低于B组低年资医师(P<0.05),两组高年资医师淋巴结检出数目[(31.1±3.3)枚比(31.5±3.5)枚]、淋巴结黑染率(76.8%比79.0%)比较差异无统计学意义(P>0.05).结论 低年资医师胃镜下先行黏膜下生理盐水注射后行纳米碳标记,有助于提高胃癌患者术中淋巴结检获数目及淋巴结黑染率.

abstractsObjective To discuss effects of different injection methods of nanocarbon tracer on gastrectomy for patients with gastric cancer. Methods Patients, who underwent D2 gastrectomy in Fuzhou General Hospital from January 2014 to December 2015, were randomly divided into group A and group B. The patients in group A were injected with nanocarbon into gastric submucosa of peripheral area of tumor under gastroscope 24 hours before operation. The patients in group B were injected with normal saline firstly, and then injected with nanocarbon. The operations were performed by 5 high qualification physicians and 3 low qualification physicians. The detection of lymph nodes and black stain nodes,detection time,and lymph node metastatic rate were compared between the two groups.Results A total of 248 patients were enrolled in this study,and each group had 124 cases. There was no statistical difference on basic characteristics between the two groups(P>0.05). A total of 2 975 and 3 855 lymph nodes were detected in group A and group B, respectively. The mean number of detected lymph nodes in group A was significantly lower than that of group B(23.9±7.9 VS 31.1±3.6, P=0.00). The rate of black stain nodes in group A was significantly lower than that of group B[71.3%(2 121/2 975)VS 78.1%(3 011/3 855), P= 0.00].There were no statistical differences on lymph node detection time(24.3±5.7 min VS 23.5±6.2 min), tiny lymph node detection rate(33.1% VS 34.9%),and lymph node metastatic rate(27.3% VS 25.8%)between the two groups(P>0.05).In subgroup of low qualification physicians, the number of lymph nodes(16.9± 4.0 VS 30.1±3.7)and the rate of black stain nodes(61.3% VS 77.2%)in group A were significantly lower than those of group B(P<0.05). The corresponding indicators(31.1±3.3 VS 31.5±3.5,76.8% VS 79.0%) had no statistical differences in the subgroup of high qualification physicians(P>0.05). Conclusion For low qualification physicians, injection of normal saline then of nanocarbon into gastric submucosa under gastroscope could improve lymph node and black stain nodes detection rate for patients with gastric cancer on gastrectomy.