Clinical Research Of Lymph Node Dissection Guided By Activate Carbon And Intraperitoneal Chemotherapy With Sustained Release 5-fluorouracil In Advanced Gastric Cancer

Objective: To investigate the significance of lymph node dissection guided by activate carbon and evaluate the safety of intraperitoneal chemotherapy with sustained release 5-fluorouracil during operation in advanced gastric cancer。Method: 66 cases of advanced distal gastric cancer were taken different lymph node dissection and intraperitoneal chemotherapy from June 2005 to January 2009.Among them, 30 cases were undergone lymph node dissection guided by activated carbon and intraperitoneal chemotherapy with sustained release 5-fluorouracil ,as the treatment group: 36 cases were used conventional lymph node dissection and one off intraperitoneal chemotherapy, as the control group; The numbers of dissected lymph nodes were compared between two groups and the characteristics of lymph node metastasis,stained effect of lymph nodes,postoperative gastrointestinal reactions,blood routin,hepatic and renal function and abdominal complications were analysisde. Results: (1) Comparison of the numbers of dissected lymph node dissection: there were 1657 lymph nodes in treatment group, an average of 55.23±11.73 / cases. In the control groupl, 1113 lymph nodes were harvested, an average of 30.97±11.33 / cases. There was statistically significant difference (P <0.05) between two groups. (2) the characteristics of lymph node metastasis: the lymph node metastasis rate was 93.3% in treatment group, and 72.2% in control group;the lymph node metastasis incidence was 32.3% in treatment group, and 28.0% in control group, There was statistically significant difference (P <0.05) between two groups. The lymph node metastasis incidence of the treatment group was significantly higher than that in control group (P <0.05) for the second station lymph node.But there were no statistically significant difference (P >0.05) between two groups for the first and third station lymph node. The common lymph node metastasis position were followed in order in treatment group : No.16, No.3, No.5, No.1, No.7, No.9, No.8, No.6, No.4, No.12, No.11. And it was : No.3, No.16, No.5, No.7, No.9, No.12, No.1, No.8, No.4, No.6, No.11 in control group . (3) The stained rate of lymph nodes in the treatment group with visual inspection: was 56.31% (933/1657). (4) Operation time:It was 217.07±37.19 min / patients in treatment group ,and it was 223.19±40.34 min / cases in control group, there no statistically significant difference(P> 0.05). (5) The accumulative rate of postoperative complications and chemotherapy drugs adverse reaction :It was 40% in treatment group,and 36.1 % in control group, there was no significant difference (P> 0.05). Conclusion : Activated carbon particles injected loacally is conducive to guiding the lymph node dissection in gastric cancer. It could increase the numbers of the dissected lymph node and more thoroughly clean the regional lymph nodes, and provide a basis for analysising reasonably the characteristics of lymph node metastasis in advanced gastric cancer; Implanting sustained release 5-fluorouraci is a safe, simple way of intraperitoneal chemotherapy.