The Clinical Study Of Carbon Nanoparticles To Lateral Lymph Nodes Dissection In Laparoscopic Rectal Cancer Radical Operation

Objective:To investigate the value of submucosal injection of Carbon Nanoparticles Suspe-nsion Injection (CNSI) on Lateral lymph node dissection (LLND) in laparoscopic midst-low position rectal cancer radical operation.Methods:60 patients with midst-low position rectal cancer were collected in Gastroin-testinal Department, Shenzhen People's Hospital from Mar 2009 to Feb 2010, and randomly divided into three groups:Group A(20 cases), laparoscopic total mesorectal excision(LTME) was performed; Group B(20 cases), submucosal injection of normal saline in the distal canal of tumor through anus was performed two to three days before LTME plus LLND; Group C (20 cases), submucosal injection of CNSI in the distal canal of tumor through anus was performed two to three days before LTME plus LLND operation. The number of resected lymph nodes, lateral lymph nodes, tiny lateral lymph nodes and traced lateral lymph nodes in group C were recorded, while the residual urine volume was measured pre-and post-operation in all the patients.Results:181,279 and 484 lymph nodes were resected in groupA, B and C respectively, si-gnificant difference between the three groups was seen in the number of lymph nodes (P< 0.05), the number of resected lymph nodes in group A was more than the other two groups. 26,(14.4%),38 (13.6%) and 59 (13.4%) metastatic lymph nodes were resected in groupA, B and C respectively. No significant difference among the three groups was seen in the number of metastatic lymph nodes (P>0.05).84 and 144 lateral lymph nodes were resected in group B and C respectively, significant difference betw-een the two groups was seen in the number of lateral lymph nodes (P<0.05).24(28.6%)and 65(45.1%)tiny lateral lymph nodes were re-sected in group B and C respectively, significant difference between the two groups were se-en in the number of tiny lateral lymph nodes (P<0.05). Lateral lymph node metastasis had been found in one and two cases of group B and C respectively, the metastatic ratio was 5% and 10%.5 (5.9%) and 12 (8.3%)metastatic lateral lymph nodes had been found in group B and C. No significant difference between the two groups was seen in the ratio of metastatic lateral lymph nodes (P>0.05). The mean operating time among the three groups were sign-ificantly different(P<0.05), the mean operating time in group A was the shortest, and the mean operating time in group C was shorter than that in group B. No significant differences among the three groups were seen in intraoperative blood loss and the residual urine volume after operation (P>0.05).Conclusion:Preoperative submucosal injection of CNSI is a reliable method to make the LLND more completely in laparoscopic radical middle and lower rectectomy. This method can also enhance the detection of the lymph nodes and the accurate tumor stage can be confirmed.