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中华普外科手术学杂志(电子版) ›› 2021, Vol. 15 ›› Issue (02) : 146 -149. doi: 10.3877/cma.j.issn.1674-3946.2021.02.009

所属专题： 文献；

论著

纳米碳与吲哚菁绿导航腹腔镜胃癌根治术淋巴结清扫的对比性研究
陆晓峰1, 刘颂2, 艾世超2, 夏雪峰2, 沈晓菲2, 宋鹏2, 康星1, 郑黎明2, 王萌2, 管文贤3,†()   
  1. 1. 210008　南京，南京医科大学鼓楼临床医学院胃肠外科
    2. 南京大学医学院附属鼓楼医院胃肠外科
    3. 210008　南京，南京医科大学鼓楼临床医学院胃肠外科；南京大学医学院附属鼓楼医院胃肠外科
  • 收稿日期:2020-09-07 出版日期:2021-04-26
  • 通信作者: 管文贤

Comparative study of carbon nanoparticles and indocyanine green-guided lymphadenectomy during laparoscopic radical gastrectomy

Xiaofeng Lu1, Song Liu2, Shichao Ai2, Xuefeng Xia2, Xiaofei Shen2, Peng Song2, Xing Kang1, Liming Zheng2, Meng Wang2, Wenxian Guan3,†()   

  1. 1. Department of Gastrointestinal Surgery, Drum Tower Clinical College of Nanjing Medical University, Jiangsu 210008, China
    2. Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Jiangsu 210008, China
    3. Department of Gastrointestinal Surgery, Drum Tower Clinical College of Nanjing Medical University, Jiangsu 210008, China; Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Jiangsu 210008, China
  • Received:2020-09-07 Published:2021-04-26
  • Corresponding author: Wenxian Guan
  • Supported by:
    National Natural Science Foundation of China(81602103;81970500); Distinguished Young Scholar Project of Medical Science and Technology Development Foundation of Nanjing Department of Health(JQX17005 and JQX19001)
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陆晓峰, 刘颂, 艾世超, 夏雪峰, 沈晓菲, 宋鹏, 康星, 郑黎明, 王萌, 管文贤. 纳米碳与吲哚菁绿导航腹腔镜胃癌根治术淋巴结清扫的对比性研究[J]. 中华普外科手术学杂志(电子版), 2021, 15(02): 146-149.

Xiaofeng Lu, Song Liu, Shichao Ai, Xuefeng Xia, Xiaofei Shen, Peng Song, Xing Kang, Liming Zheng, Meng Wang, Wenxian Guan. Comparative study of carbon nanoparticles and indocyanine green-guided lymphadenectomy during laparoscopic radical gastrectomy[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2021, 15(02): 146-149.

目的

对比纳米碳与吲哚菁绿(ICG)在腹腔镜胃癌根治术淋巴结清扫方面的优劣性。

方法

回顾性分析2016年1月至2019年12月接受腹腔镜胃癌根治术的167例患者资料，根据所使用的示踪剂种类，分为纳米碳组130例、ICG组37例，应用GraphPad Prism 8.0统计软件进行分析，围术期指标及淋巴结清扫数目等计量资料以(±s)表示，采用独立t检验；术后并发症、二次手术率等计数指标比较采用χ2检验，P<0.05为差异有统计学意义。

结果

两种示踪剂对不同病理分期胃癌的淋巴结清扫效果差异无统计学意义。在各种胃癌根治术式中，淋巴结分拣均有助于提高淋巴结总检出数。纳米碳组较ICG组更有助于提高根治性全胃切除术第5站淋巴结的清扫数目(P＝0.02)、根治性近端胃切除术第1站淋巴结的清扫数目(P＝0.03)以及根治性远端胃淋巴结的总清扫数目(P＝0.03)。在提高淋巴结检出率方面，两种示踪剂差异无统计学意义。

结论

纳米碳与吲哚菁绿在不同病理分期中的总体淋巴结清扫效果差异无统计学意义。无论使用何种示踪剂，均提倡淋巴结分拣。纳米碳较吲哚菁绿更有助于提高根治性全胃第5站淋巴结的清扫数、根治性近端胃第1站淋巴结的清扫数以及根治性远端胃淋巴结的总清扫数目。

关键词: 胃肿瘤, 腹腔镜检查, 纳米管, 碳, 吲哚菁绿, 淋巴结
Objective

To compare the advantages between carbon nanoparticles (CN) and indocyanine green (ICG)-guided lymphadenectomy in laparoscopic radical gastrectomy.

Methods

Between January 2016 and December 2019, clinical data of 167 patients underwent laparoscopic radical gastrectomy were analyzed retrospectively. Among them, 130 patients received CN-guided gastrectomy and the other 37 patients received ICG-guided gastrectomy. GraphPad Prism 8.0 was employed for data analysis. Measurement data were presented as, and analyzed by using unpaired t-test. Count data were presented as frequency, and were compared by using χ2 test. A P value of <0.05 was considered as statistical significant difference.

Results

The total number of harvested lymph nodes were similar in patients with same pathological stage. Lymph node examination could improve the number of retrieved lymph nodes. CN is superior to ICG in the harvest of No.5 lymph nodes in laparoscopic total gastrectomy, No.1 lymph nodes in laparoscopic proximal gastrectomy and total number in laparoscopic distal gastrectomy. Statistical difference in the positive rate of lymph node was not observed between two groups.

Conclusions

The effect of CN and ICG in guiding lymph node dissection was similar in patients with same pathological stage. Lymph node examination should be encouraged in laparoscopic radical gastrectomy. CN was superior than ICG in the harvest of No.5 in laparoscopic total gastrectomy, in the harvest of No.1 in laparoscopic proximal gastrectomy and total number of lymph nodes in laparoscopic distal gastrectomy.

Key words: Stomach neoplasms, Laparoscopy, Nanotubes, carbon, Indocyanine green, Lymph nodes
表1 167例胃癌根治术术中不同示踪剂两组患者的一般基线资料比较[(±s)，例]
组别 例数 年龄(岁) 性别 病理分期
男/女 Ⅰ/Ⅱ/Ⅲ
纳米碳组 130 58.5±11.2 78/52 77/26/27
ICG组 37 59.1±12.9 27/10 29/3/5
t/χ2   0.25 1.13 4.80
P值   0.81 0.18 0.09
图1 内镜下注射纳米碳与吲哚菁绿用于腹腔镜胃癌根治术示意图[A.胃癌病灶；B.于病灶口侧黏膜下注射纳米碳；C.于病灶肛侧黏膜下注射纳米碳；D.于病灶口侧与肛侧分别注射吲哚菁绿]
表2 167例胃癌根治术术中不同示踪剂两组患者围术期指标比较(±s)
组别 例数 手术时长(min) 术中出血量(ml) 术后住院天数(d)
纳米碳组 130 250.5±55.2 142.7±107.1 11.8±3.9
ICG组 37 260.8±43.4 145.9±72.1 13.0±8.7
t/χ2   1.04 0.17 1.24
P值   0.30 0.86 0.21
组别 例数 术后并发症(例) 二次手术(例)
纳米碳组 130 13 2
ICG组 37 2 1
t/χ2   0.89 1.17
P值   0.53 0.53
表3 167例胃癌根治术术中不同示踪剂两组患者不同病理分期淋巴结清扫数目比较(±s)
组别 例数 Ⅰ期 Ⅱ期 Ⅲ期
纳米碳组 130 27.0±11.7 31.9±10.4 31.6±10.0
ICG组 37 23.8±8.3 32.3±17.4 29.8±13.3
t值   1.34 0.07 0.36
P值   0.19 0.94 0.72
表4 167例胃癌根治术术中不同示踪剂两组患者各站淋巴结的清扫数目比较(±s)
组别 例数 根治性全胃切除术(第5站淋巴结) 根治性远端胃切除术(各站淋巴结总数) 根治性近端胃切除术(第1站淋巴结)
纳米碳组 130 2.0±2.2 29.2±11.7 6.1±3.3
ICG组 37 0.5±0.5 22.2±6.0 1.8±1.5
t值   2.40 2.16 2.48
P值   0.02 0.03 0.03
表5 167例胃癌根治术术中不同示踪剂两组患者淋巴结检出阳性率[(±s), %]
组别 例数 根治性全胃切除术 根治性远端胃切除术 根治性近端胃切除术
纳米碳组 130 80.1±16.7 81.3±12.8 74.0±25.9
ICG组 37 80.1±18.2 71.4±24.7 80.0±19.7
t值   7.43 1.53 0.74
P值   0.99 0.16 0.48
表6 167例胃癌根治术术中不同示踪剂两组患者淋巴结分拣对淋巴结检出数目的影响(±s)
组别 淋巴结分拣 例数 根治性全胃切除术 根治性远端胃切除术 根治性近端胃切除术
纳米碳组 未分拣 35 25.5±7.6 25.2±9.1 16.0±4.2
分拣 95 31.9±11.2 30.8±12.4 24.2±10.0
t值   1.881 1.852 1.10
P值   0.07 0.07 0.30
ICG组 未分拣 14 24.0±11.6 23.4±4.9 17.3±5.0
分拣 23 32.7±11.7 21.0±7.1 21.5±5.4
t值   1.288 0.75 1.03
P值   0.22 0.47 0.35
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