摘要
[目的]探讨超声内镜引导下纳米炭联合钛夹标记对贲门癌手术方式的选择及定位作用.[方法]将48例经内镜及病理初次确诊的贲门癌患者随机分为纳米炭联合钛夹标记组(T组,25例)与非标记组(C组,23例).T组于术前3 d内行超声内镜评估病灶浸润深度及潜行范围,然后超声内镜引导下行纳米炭联合钛夹标记,术后行腹部平片,根据钛夹与第10胸椎(T10)相对位置及其他常规术前检查选择合适的手术入路,进而指导后续手术时的对于病灶定位及切除.C组仅根据白光胃镜及其他术前检查决定手术入路.比较2组手术入路方式、术中探查病灶时间、总手术时间、首次切缘阳性率、近端切缘距病灶长度.[结果]T组25例均在超声胃镜引导下完成纳米炭及钛夹标记,标记过程中无出血和穿孔等并发症发生,无不良反应;术中均清晰可见纳米炭标记点;1例患者钛夹脱落,钛夹位于T10以下患者20例,排除禁忌均行经腹腔入路方式手术,余患者经胸腔入路手术.C组23例结合检查结果经腹腔入路手术患者12例,经胸腔入路患者11例.T组经胸入路、经腹入路分别为20.00％、80.00％,C组分别为52.20％、47.80％,2组的手术入路方式比较P=0.020;T组术中探查病灶时间为(4.96±2.04)min,短于C 组的(17.65±2.42)min,2 组比较 P＜0.001;T 组总手术时间为(145.76±43.85)min,短于 C 组的(171.95±34.17)min,2组比较P=0.026;T组近端切缘距病灶长度、首次切缘阳性率分别为(2.63±0.83)cm、4.00％,C组分别为(3.89±0.99)cm、17.39％,2组比较,P＜0.001、P=0.180.所有患者均无术中及术后并发症,无围手术期死亡.[结论]超声内镜引导下可根据贲门部肿瘤实际浸润范围进行纳米炭联合钛夹标记,标记更加准确,结合钛夹的高度位置有助于外科手术入路的选择,标记后术中可对原始病灶的准确定位及切除,提高手术的精准性,减少患者创伤.
Abstract
[Objective]To explore the selection of surgical method and localization of EUS guided carbon nanoparticles combined with titanium clip tattooing in cardia cancer..[Methods]A total of 48 patients with cardiac cancer diagnosed for the first time by endoscopy and pathology were randomly divided into two groups:carbon nanoplate combined with titanium clip labeled group(group T)and unlabeled group(group C).The group T underwent EUS guided carbon nanoparticles combined with titanium clip tattooing one week before the surgery,then a abdominal plain film was taken to mark the original lesion location and guiding the subsequent additional surgery.Only white light gastroscopy and other preoperative examina-tions were used to determine the surgical approach in group C.The following parameters were compared:surgical approach,identifyication time,operation time and distance from lesion to operation proximal mar-gin;the rate of first positive margin.[Results]Forty-eight patients were involved in this study,including 25 cases in group T and 23 cases in group C.No bleeding,no perforation and no adverse reaction occurred when tattooed.All carbon nanoparticles tattooings were clearly visible under the naked eye.The titanium clip fell off in one case,there were 20 patients with titanium clips above T10,all of whom were operated through intraperitoneal approach without contraindications,and the remaining patients were operated through thoracic approach.12 patients were operated through intraperitoneal approach and 11 patients were operated through thoracic approach in group C.Significant differences favoring tatooing were found with regard to surgical approach(thoracic approach 20.00％vs 52.20％,intraperitoneal approach 80.00％vs 47.80％,P=0.034),identification time([4.96±2.04]min vs[17.65±2.42]min,P＜0.001),operation time([145.76±43.85]min vs[171.95±34.17]min,P=0.026),distance from lesion to operation proximal margin([2.63±0.83]cm vs[3.89±0.99]cm,P＜0.001).The rate of first positive resection margin(4.00％vs 17.39％,P=0.180)in group T were lower than that in group C,while there was no statistical difference in comparison between two groups.There was no postoperative complications and no periopera-tive mortality.[Conclusion]Carbon nanoparticles combined with titanium clip can be tattooed according to the actual infiltration range of cardiac tumor under the guidance of endoscopic ultrasonography,which is more accurate and helpful for the accurate location in surgery.It is also helpful for the selection of surgi-cal approach combined with the height position of the titanium clip,so it can improve the safety and preci-sion of cardiac cancer surgical procedures after tattooing.
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