| Objective: To applied the carbon nanoparticles suspension injection to laparoscopic radical gastrectomy for advanced gastric cancer, and to observe the effect of CNSI labeled lymph nodes and whether it can improve the number of lymph node dissection, and to explore the clinical value, necessity, feasibility and advantage of laparoscopic technique combined with Sentinel lymph node mapping for advanced gastric cancer radical lymph node dissection.Methods: Between January 2014 and June 2015, 635 cases of gastric cancer were selected in the department of general surgery of Second Hospital Affiliated to Lanzhou University. All patients were diagnosed as gastric cancer by electronic gastroscopy and pathology. Establish the patient’s clinical data archives(age, gender, TNM stage, tumor size, surgical procedures, histological type and BMI). According to the clinical data of patients to determine the patient’s TNM, excluding non-compliant patients, a total of 120 patients with advanced gastric cancer were included. According to the order of hospitalization,the patients were randomly divided into experimental group and control group, with 60 cases in each group. All patients underwent laparoscopic radical gastrectomy for advanced gastric cancer. CNSI was applied to operation in the experimental group, and the control group wasn’t gave any drug injection.Seized lymph nodes from specimens and counts of lymph node number and diameter,measurement of tumor size, statistics of the department of pathology, check out the number of metastatic lymph nodes and the degree of tumor invasion of the stomach wall,patients were followed up regularly.Results: There was no significant difference between the two groups in normal information(age, sex,BMI, TNM stage, tumor size, surgical procedure, and the type of weave)(P > 0.05);The total number of lymph node dissection in the experimental group was 2359, and the control group was 1714. The average number of lymph node dissectionin the experimental group(39.32±7.72)was significantly higher than that in the control group(28.57 ± 6.40), the difference was significant(t=8.305, P=0.000 < 0.01).In the experimental group and the control group, the average number of small lymph nodes was(8.72 ± 4.09) vs(5.62 ± 3.42), the difference was significant(t=4.502, P=0.000 < 0.01).In the experimental group, the number of black stained lymph nodes was 1373, and the black dyeing rate was 58.20%(1373/2359).In the experimental group, metastasis rate was 75%(45/60), the control group was 71.7%(43/60);the experimental group transfer rate was higher than the control group, but no significant difference was not statistically significant(P > 0.05).The average number of lymph nodes in the experimental group was(7.52±4.87) was significantly higher than that in the control group(3.47±3.37), which was statistically significant(P < 0.05).The lymph node metastasis rate of the experimental group was 19.12%(451/2359) was significantly higher than that in the control group 14.88%(255/1714)(?2=12.45,P < 0.01).The lymph node metastasis rate of 23.16%(318/1373) was significantly higher than 14.88%(255/1714), and the difference was statistically significant(?2=34.57,P < 0.05).Patients in the experimental group were followed up for an average of(9.75±3.97) month and control(10.33±4.16)month group, no significant difference(P > 0.05); the experimental group and the control group in patients with recurrent rate(?2=0.901, P = 0.529) and mortality(?2=1.034, 0.609)showed no significant difference(P > 0.05).Conclusion: The CNSI could fastly staining gastric lesions peripheral lymphoid tissue, with the ability to rapidly labeled. The anatomical spaces of lymphatic tissue labeled and the surrounding tissue were more clear, and it was good at guiding the choice of surgical approach and lymph node dissection. CNSI applied can obtain more lymph node dissection number, number of lymph nodes and small lymph nodes metastasis. Laparoscopic technique combined with Sentinel lymph node mapping applied in advanced gastric cancer can get better minimally invasive effect and curative effect. |
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