目的:新辅助治疗后局部淋巴结(LN)体积减少,需要示踪剂更准确的检测。纳米碳示踪剂是第三代示踪剂,具有多种优点,但其在中低位直肠癌新辅助放化疗后LN检测中的应用尚不清楚.因此,这项研究调查了在该患者人群中肛门镜引导下直肠下注射纳米碳混悬液的效果和安全性.
方法:本研究回顾性分析了我院2019年3月至2022年3月收治的45例中低位直肠癌患者的病历。所有患者术前均接受新辅助化疗和放疗,分为纳米碳注射组(n=23;术前24h肛门镜引导下在齿状线以上2cm的直肠粘膜下层注射纳米碳混悬液)和对照组(n=22;直接接受手术)。比较两组患者的LN检出率和并发症发生率。
结果:纳米碳注射组LN和小LN的总数和平均数以及>12LN的患者人数明显高于对照组。阳性LN和LN转移的总数在组间没有差异,吻合口漏也没有,出血,狭窄,脓肿发生率。
结论:阳极镜引导的纳米碳淋巴示踪提高了LN的检出率,造成的创伤较小,与直接外科手术相比,术后并发症较少。因此,这是一个有效的,安全,和实用的方法,可以提高解剖和术后病理分期的准确性。
OBJECTIVE: Regional lymph node (LN) volume decreases after neoadjuvant therapy, requiring a
tracer for more accurate detection. Nano-carbon
tracer is a third-generation
tracer with several advantages, but its use for LN detection after neoadjuvant chemoradiotherapy for middle and low rectal cancer remains unclear. Therefore, this study investigated the effects and safety of anoscope-guided subrectal injections of nano-carbon suspension in this patient population.
METHODS: This study retrospectively reviewed the medical records of 45 patients with middle and low rectal cancer admitted to our institution from March 2019 to March 2022. All patients received preoperative neoadjuvant chemotherapy and radiotherapy and were divided into nano-carbon injection (n = 23; anoscope-guided injections of nano-carbon suspension in the rectal submucosa 2 cm above the dentate line 24 h preoperatively) and control (n = 22; directly underwent surgery) groups. The LN detection and complication rates were compared between the groups.
RESULTS: The total and mean numbers of LNs and small LNs and the number of patients with > 12 LNs were significantly higher in the nano-carbon injection group than in the control group. The total number of positive LNs and LN metastasis did not differ between the groups, nor did the anastomotic leakage, bleeding, stenosis, and abscess occurrence rates.
CONCLUSIONS: Anoscope-guided nano-carbon lymphatic tracing increased the LN detection rate, caused less trauma, and resulted in fewer postoperative complications than the direct surgical procedure. Thus, it is an effective, safe, and practical method that may improve dissections and the postoperative pathological staging accuracy.