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目的探讨纳米炭淋巴示踪剂对局部进展期胃癌术前化疗(NCT)联合手术治疗后检获淋巴结的影响。方法选取2014年1月—2015年1月河北医科大学第四医院外三科收治的局部进展期胃癌患者76例为研究对象,其均接受NCT后进行手术。采用随机数字表法将患者分为纳米炭组和对照组,各38例。纳米炭组在术前给予淋巴结示踪剂。比较两组淋巴结检获情况、淋巴结转移率、淋巴结黑染率及淋巴结病理分期(pN)情况。结果纳米炭组共检获淋巴结1 328枚,平均(35.2±8.3)枚/人;对照组共检获淋巴结945枚,平均(24.6±6.8)枚/人,纳米炭组淋巴结检获量高于对照组,差异有统计学意义(t=7.45,P<0.05)。纳米炭组长径<5 mm的淋巴结检获率为62.5%(830/1 328),高于对照组的42.1%(398/945),差异有统计学意义(χ~2=92.30,P<0.05)。纳米炭组转移淋巴结检出率为13.7%(182/1 328),高于对照组的10.2%(96/945),差异有统计学意义(χ~2=6.46,P<0.05)。纳米炭组黑染淋巴结914枚,黑染率为68.8%(914/1 328);黑染淋巴结中转移淋巴结检出率为17.9%(164/914);未黑染淋巴结中转移淋巴结检出率为4.3%(18/414);黑染淋巴结的转移淋巴结检出率高于对照组及未黑染淋巴结,差异均有统计学意义(χ~2=23.40、44.53,P<0.05)。纳米炭组pN0为3例(7.9%)、pN1为19例(50.0%)、pN2+pN3为16例(42.1%),对照组pN0为12例(31.6%)、pN1为16例(42.1%)、pN2+pN3为10例(26.3%),两组pN比较,差异有统计学意义(χ~2=7.04,P<0.05)。两组患者均未出现明显毒副作用及手术相关并发症。结论纳米炭淋巴示踪剂能提高阳性淋巴结及小淋巴结检出率,有助于提高局部进展期胃癌NCT后精确的pN分期,且安全性好。
Objective To investigate the effect of nanocarbon lymphatic tracer on the detection of lymph node in patients with locally advanced gastric cancer treated with preoperative chemotherapy (NCT) combined with surgical treatment. Methods From January 2014 to January 2015, 76 patients with locally advanced gastric cancer who were admitted to the third department of Hebei Medical University Fourth Hospital were enrolled in this study. All patients underwent NCT after operation. Patients were divided into nano-carbon group and control group using random number table method, 38 cases each. Nanocarbon group before surgery to give lymph node tracer. Lymph node acquisition, lymph node metastasis, lymph node black staining and lymph node staging (pN) were compared between the two groups. Results A total of 1 328 nodes (35.2 ± 8.3) / person were detected in the nanocarbon group. 945 lymph nodes were found in the control group (mean, 24.6 ± 6.8) / person. The number of lymph nodes in the nanocarbon group was significantly higher than that in the control group The difference was statistically significant (t = 7.45, P <0.05). In the nanocarbon group, the detection rate of lymph nodes with a diameter of less than 5 mm was 62.5% (830/1 328), which was higher than that of the control group (42.1%, 398/945) (χ ~ 2 = 92.30, P <0.05 ). The detection rate of metastatic lymph nodes in the nanocarbon group was 13.7% (182/1 328), which was higher than that in the control group (10.2%, 96/945) (χ ~ 2 = 6.46, P <0.05). There were 914 black-stained lymph nodes in the nano-charcoal group with a black stained rate of 68.8% (914/1 328). The positive rate of metastatic lymph nodes in black stained lymph nodes was 17.9% (164/914) Was 4.3% (18/414). The detection rate of metastatic lymph nodes in black-stained lymph nodes was higher than that in control and non-black-stained lymph nodes (χ ~ 2 = 23.40,44.53, P <0.05). In the carbon nanocarbon group, pN0 was found in 3 cases (7.9%), pN1 in 19 cases (50.0%), pN2 + pN3 in 16 cases (42.1%), control group pN0 in 12 cases (31.6% ), PN2 + pN3 was 10 cases (26.3%). There was significant difference in pN between the two groups (χ ~ 2 = 7.04, P <0.05). No significant adverse side effects and surgery-related complications occurred in both groups. Conclusion Nanocarbon lymphatic tracer can improve the detection rate of positive lymph nodes and small lymph nodes, and help to improve the accurate pN stage after NCT of locally advanced gastric cancer with good safety.