| Objective:Perform the titanium clip +nano-carbon "double-labeled" at the height of the actual tumor infiltration under the preoperative ultrasound endoscopy,perform a plain abdominal film immediately to confirm the height,compare this height with the 10th thoracic vertebral body to guide the surgical approach,During the operation,we touch the titanium clip and observe the black staining area to complete the precise removal of the lesion.Methods:Through a prospective study,60 patients who were diagnosed with AEG by endoscopic pathological biopsy were selected from the February 1,2018 to December 31,2019 at 900 Hospital of the Joint Logistics Team.All patients were randomly divided into a double-labeled group with titanium clips and nano-carbon and a non-double-labeled group("double-labeled" group and conventional group),30 cases in each group.After completing the relevant routine examinations,the"dual-label" group underwent endoscopic ultrasonography with titanium clips+nano-carbon "dual-label" 1-2 days before surgery,1 cm from the mouth of the longest infiltration site on the longitudinal axis of the tumor was detected.The position was marked by subcutaneous injection of nano-carbon suspension,Then marked with two titanium clips on the same height,and immediately took a plain abdominal film to confirm the height of them.The regular group is not marked.We decided the surgical approach based on the height of the titanium clip and the routine examination in"double standard" group,We decided it based on the preoperative examination.Recorded the"double-labeled" group’s "dual standard" situation and the surgical and pathological indicators.After operation,all the proximal cutting edge specimens were made into continuous paraffin sections(0.4 cm per section).Under an electron microscope,each layer was observed for tumor cells.Finally,the two groups of data were statistically analyzed.Results:(1)During the operation,24 cases in the "double-label" group were successfully marked,2 cases of titanium clips fell off;4 cases of nano-carbon were poorly marked.(2)The time for exploring the upper margin of tumor(1.44±0.73min vs.1.98±0.65min,P=0.030)was statistically different between the two groups;the surgical approach(transthoracic approach 56.67%vs.70.00%),transabdominal approach 43.33%vs.30.00%,P=0.284),intraoperative frozen pathology positive rate(3.33%vs.10.00%,P=0.301),hospital stay(19.27±5.02 days vs.19.20±4.27 days,P=0.956)and postoperative complications(26.67%vs.30.00%,P=0.783)were not statistically different.(3)Length of anterior tumors from the proximal resection margin(3.59±1.35cm vs.4.25±1.19cm,P=0.049)in the "double-labeled" and conventional groups,the length after leaving the body(2.39 ±0.86cm vs.2.86±0.75cm,P=0.029)and the length after fixation(1.89±0.73cm vs.2.26±0.65cm,P=0.044)were statistically different.The length of tumor infiltration into the esophagus(0.75±0.72cm vs.1.07±0.87cm,P=0.120)was no statistically different.Conclusions:The titanium clip+nano-carbon "dual-label" technology to mark the boundary of the actual infiltration of the adenocarcinoma of esophagogastric junction under preoperative ultrasound endoscopy with direct vision,providing an objective basis for the choice of surgical approach and avoiding the normal esophagus excessive and insufficient excision to achieve the precise excision.In the surgical operation of adenocarcinoma of esophagogastric junction,it is a fast,effective and safe positioning technology. |
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