纳米炭染色结直肠癌淋巴结分站对比研究_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

黎川 , 谭浩冬 , 肖俊杰 , 徐翔 , 胡兰心 , 张雪飞 , 张宜 , 苏晨 , 杜俊锋 ,  张宏宇

重庆医科大学附属第一医院胃肠外科（重庆 400042）;

Corresponding author：

张宏宇, Email: zhy86@hotmail.com

Keywords：

结直肠癌; 纳米炭; 淋巴结

DOI：

10.7507/1007-9424.202311068

Video：

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目的探究纳米炭染色对结直肠癌淋巴结示踪的规律以及对转移淋巴结检出的影响。方法回顾性收集2022年4月至2023年9月期间于重庆医科大学附属第一医院胃肠外科接受腹腔镜结直肠癌根治性手术及术前行肿瘤纳米炭标记的92例患者的标本。新鲜标本淋巴结按第一站、第二站及第三站分检，各站又分为染色组和未染色组。比较各组间及组内不同站不同染色程度淋巴结的差异。结果共纳入92例患者，共分检出淋巴结2 859枚，其中转移淋巴结66枚（2.3%），未转移2 793枚（97.7%）；黑染淋巴结2 167枚（75.8%），未染色692枚（24.2%）。淋巴结染色率从第一到第三站逐渐递增（P＜0.017）；第一站和第二站转移淋巴结的染色率比同站所有淋巴结染色率低（χ²=23.959，P<0.001；χ²=7.187，P=0.007），但在第三站中差异无统计学意义（χ²=1.155，P=0.283）；第一站和第二站染色淋巴结转移率小于未染色淋巴结（χ²=26.224，P<0.001；χ²=7.520，P=0.006），但第三站中差异无统计学意义（χ²=1.232，P=0.267）。结论纳米炭淋巴结示踪效果随着淋巴回流逐渐增强。在第一站和第二站，其对于转移淋巴结的显示缺乏特异性，手术及分检过程中应更关注未染色淋巴结。在第三站淋巴结中，能够更有效地示踪转移淋巴结，可按染色淋巴结进行针对性地淋巴结清扫。

Citation： 黎川, 谭浩冬, 肖俊杰, 徐翔, 胡兰心, 张雪飞, 张宜, 苏晨, 杜俊锋, 张宏宇. 纳米炭染色结直肠癌淋巴结分站对比研究. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(4): 469-473. doi: 10.7507/1007-9424.202311068 Copy

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14.	赵玉洲, 韩广森, 霍明科, 等. 纳米碳示踪技术联合动脉血管入路淋巴结分检法在乙状结肠癌根治术中的应用价值. 中华消化外科杂志, 2018, 17(2): 168-172.
15.	Gately L, Jalali A, Semira C, et al. Stage dependent recurrence patterns and post-recurrence outcomes in non-metastatic colon cancer. Acta Oncol, 2021, 60(9): 1106-1113.
16.	Zhang C, Zhang L, Xu T, et al. Mapping the spreading routes of lymphatic metastases in human colorectal cancer. Nat Commun, 2020, 11(1): 1993. doi: 10.1038/s41467-020-15886-6.
17.	Zhang RJ, Chen YL, Deng X, et al. Carbon nanoparticles for thyroidectomy and central lymph node dissection for thyroid cancer. Am Surg, 2023, 89(6): 2227-2236.
18.	Wei N, Hou J, Chen J, et al. Sentinel lymph node biopsy with carbon nanoparticle suspension after neoadjuvant chemotherapy for breast cancer patients. Ann R Coll Surg Engl, 2021, 103(10): 752-756.
19.	杨斌, 李英儒, 温润龙, 等. 纳米碳淋巴示踪技术应用于腹腔镜结直肠癌根治术的意义. 中华胃肠外科杂志, 2015, 18(6): 549-552.
20.	Wang LY, Li JH, Zhou X, et al. Clinical application of carbon nanoparticles in curative resection for colorectal carcinoma. Onco Targets Ther, 2017, 10: 5585-5589.
21.	Royston D, Jackson DG. Mechanisms of lymphatic metastasis in human colorectal adenocarcinoma. J Pathol, 2009, 217(5): 608-619.
22.	Karaman S, Detmar M. Mechanisms of lymphatic metastasis. J Clin Invest, 2014, 124(3): 922-928.
23.	Ge W, Li Q, Liu WJ, et al. Carbon nanoparticle suspension could help get a more accurate nodal staging for patient with rectal cancer. Sci Rep, 2021, 11(1): 9933. doi: 10.1038/s41598-021-89541-5.

1. Siegel RL, Wagle NS, Cercek A, et al. Colorectal cancer statistics, 2023. CA Cancer J Clin, 2023, 73(3): 233-254.
2. Pawlik TM, McMasters KM. Practice-changing evidence in surgical oncology: an Annals of Surgical Oncology series. Ann Surg Oncol, 2023, 30(4): 1930-1931.
3. Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol, 2010, 17(6): 1471-1474.
4. Labianca R, Nordlinger B, Beretta GD, et al. Early colon cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol, 2013, 24 Suppl 6: vi64-vi72.
5. Liu P, Tan J, Tan Q, et al. Application of carbon nanoparticles in tracing lymph nodes and locating tumors in colorectal cancer: a concise review. Int J Nanomedicine, 2020, 15: 9671-9681.
6. Tang L, Sun L, Zhao P, et al. Effect of activated carbon nanoparticles on lymph node harvest in patients with colorectal cancer. Colorectal Dis, 2019, 21(4): 427-431.
7. Li K, Li Z, Yan B, et al. Preoperative carbon nanoparticle injection improves inferior mesenteric artery lymph node retrieval in patients with rectal cancer. Surgery, 2022, 171(5): 1177-1184.
8. 吴锡斌, 张宏宇. 内镜下注射纳米炭在腹腔镜下结直肠癌根治术中的应用. 现代医药卫生, 2019, 35(13): 1971-1974.
9. Cai HK, He HF, Tian W, et al. Colorectal cancer lymph node staining by activated carbon nanoparticles suspension in vivo or methylene blue in vitro. World J Gastroenterol, 2012, 18(42): 6148-6154.
10. Pan L, Ye F, Liu JJ, et al. A study of using carbon nanoparticles to improve lymph nodes staging for laparoscopic-assisted radical right hemicolectomy in colon cancer. Int J Colorectal Dis, 2018, 33(8): 1131-1134.
11. 蔡嘉伟, 李小兰, 陈曦, 等. 纳米碳淋巴结示踪剂在结直肠癌根治术中的应用. 中华胃肠外科杂志, 2020, 23(10): 990-995.
12. 梁贤文, 王绥能, 彭勃. 纳米碳示踪技术在直肠癌患者腹腔镜下保留左结肠动脉及清扫第253组淋巴结中的应用. 武汉大学学报 (医学版), 2020, 41(1): 48-51.
13. 中华医学会消化内镜学分会. 消化内镜下纳米炭注射标记定位技术临床操作专家共识. 中华消化内镜杂志, 2022, 39(11): 860-869.
14. 赵玉洲, 韩广森, 霍明科, 等. 纳米碳示踪技术联合动脉血管入路淋巴结分检法在乙状结肠癌根治术中的应用价值. 中华消化外科杂志, 2018, 17(2): 168-172.
15. Gately L, Jalali A, Semira C, et al. Stage dependent recurrence patterns and post-recurrence outcomes in non-metastatic colon cancer. Acta Oncol, 2021, 60(9): 1106-1113.
16. Zhang C, Zhang L, Xu T, et al. Mapping the spreading routes of lymphatic metastases in human colorectal cancer. Nat Commun, 2020, 11(1): 1993. doi: 10.1038/s41467-020-15886-6.
17. Zhang RJ, Chen YL, Deng X, et al. Carbon nanoparticles for thyroidectomy and central lymph node dissection for thyroid cancer. Am Surg, 2023, 89(6): 2227-2236.
18. Wei N, Hou J, Chen J, et al. Sentinel lymph node biopsy with carbon nanoparticle suspension after neoadjuvant chemotherapy for breast cancer patients. Ann R Coll Surg Engl, 2021, 103(10): 752-756.
19. 杨斌, 李英儒, 温润龙, 等. 纳米碳淋巴示踪技术应用于腹腔镜结直肠癌根治术的意义. 中华胃肠外科杂志, 2015, 18(6): 549-552.
20. Wang LY, Li JH, Zhou X, et al. Clinical application of carbon nanoparticles in curative resection for colorectal carcinoma. Onco Targets Ther, 2017, 10: 5585-5589.
21. Royston D, Jackson DG. Mechanisms of lymphatic metastasis in human colorectal adenocarcinoma. J Pathol, 2009, 217(5): 608-619.
22. Karaman S, Detmar M. Mechanisms of lymphatic metastasis. J Clin Invest, 2014, 124(3): 922-928.
23. Ge W, Li Q, Liu WJ, et al. Carbon nanoparticle suspension could help get a more accurate nodal staging for patient with rectal cancer. Sci Rep, 2021, 11(1): 9933. doi: 10.1038/s41598-021-89541-5.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

纳米炭染色结直肠癌淋巴结分站对比研究

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