| Objective:In this paper,prospective studies were conducted to select eligible gastric cancer patients,and to explore the application value of nanocarbon lymphatic tracer technology in D2 gastric cancer radical operation(total gastrectomy + Roux-en-Y anastomosis)and different use methods of nanocarbon lymphatic tracer,so as to provide some help for patients undergoing D2 gastric cancer radical operation and improve the accuracy of Postoperative pathological staging.Methods:In this study,90 patients with gastric cancer were screened and diagnosed in Gastrointestinal Center of the Northern Jiangsu people’s Hospital after January 1,2019 were diagnosed with gastric cancer by preoperative gastroscopy.The selected 90 patients was randomly separated into two groups with random number table method: the the experimental group(nanocarbon group)and the control group,there are 45 patients in one group.In the nanocarbon group,Carbon Nanoparticles Suspension Injection was used before or during the operation.Furthermore,the patients in the nanocarbon group were randomly divided into 3 subgroups according to different injection methods using the same random number table method,namely the intraoperative open serosa group,intraoperative laparoscopy serosa group and preoperative endoscopic mucosal group.The general condition before operation,intraoperative condition,lymph node dissection,postoperative recovery and follow-up of patients in the nanocarbon group and the control group were compared.At the same time,the relative effects of three different injection methods in the nanocarbon group on lymph node dissection were further analyzed.Result:In terms of the findings,no significant differences were found in clinical data(age,gender,BMI,basic diseases,tumor pathological staging)between the two groups before surgery(P>0.05).The operating time of the two groups was(172.62±37.09min)and(172.01 ± 35.46)respectively,and no significant differences were found in this parameter(P>0.05).The intraoperative blood loss of the experimental group and the control group was(169.78±67.03ml)and(187.78±35.60min)respectively,and there was no significant difference(P>0.05).1470 and 894 lymph nodes were detected in the two groups,respectively(32.67±6.26)and(19.87±3.22)in each patient.The comparison and analysis of the two groups were statistically different(P<0.05).The incidence of lymph node metastasis between the two was 71.1%(32/45)and 64.4%(29/45)respectively,and there was no significant statistical difference(P>0.05).The two groups of positive lymph nodes were271 and 185 respectively,and the metastasis rates were 18.44%(271/1470)and 20.69%(185/894)respectively,and there was no significant statistical difference(P>0.05).538 and 276 micro lymph nodes(diameter less than 5mm)were detected in the two groups,respectively(11.96±2.08)and(6.13±2.00)in each patient.The comparison and analysis of the two groups were statistically different(P=<0.05).The numbers of positive lymph nodes were 271 and 171 respectively,and the numbers of black stained lymph nodes were 785 and 685 respectively.The metastasis percentage of black and non-black stained lymph nodes was 21.7%(171/785)and 14.60%(100/685),the two groups are statistically different(P<0.05).The postoperative exhaust time of the two groups was(4.24±0.93 days)and(4.33±1.02 days)respectively,and no significant differences were found in these two groups(P>0.05).The postoperative drainage volume of the experimental group(the nanocarbon group)and the control group were(518.47±140.77ml)and(684.89±172.12ml)respectively,and significant differences were found with these two groups(P < 0.05).The postoperative extubation time of the tested groups(the experimental group and the control group)was(6.93±1.27 days)and(6.76±1.25 days)respectively,no significant differences were found in these two groups(P>0.05).The postoperative hospital stays the tested groups(the experimental group and the control group)were(14.51±3.00 days)and(13.98±2.09 days)respectively,no significant differences were found in these two groups(P>0.05).The total hospitalization expenses of the tested groups(the experimental group and the control group)were(5.50±0.55million)and(5.59±6,400)respectively,and there was no significant statistical difference(P>0.05).A total of 7 cases and 8 cases of the two groups of patients had postoperative complications.The incidence rate was 15.6%(7/45)and 17.8%(8/45).There was no significant statistical difference(P>0.05).The three-month follow-up of the two groups of patients was successful.There were no deaths.There were 2 cases of recurrence and metastasis,6 cases of highly suspected recurrence and metastasis and 37 cases of no recurrence and metastasis in the nano carbon group.There were 3 cases of recurrence and metastasis,11 cases of highly suspected recurrence and metastasis and 31 cases of no recurrence and metastasis in the control group,with no significant difference(P >0.05).Comparison of lymph node dissection among the three different injection subgroups in the nanocarbon group: intraoperative open serosa group,intraoperative laparoscopic serosa group and preoperative endoscopic mucosal group detected lymph nodes(31.67±5.77 pieces),(29.80±5.97)and(36.53±5.34),the comparative analysis showed statistical difference(P<0.05).Patients in the endoscopic mucosal group had to detect more lymph nodes before operation.The number of micro lymph nodes detected in the three groups were(11.80±1.74),(11.60±2.41)and(12.47±2.07)respectively,and there was no significant statistical difference(P>0.05).The numbers of black-stained lymph nodes in the three groups were(16.47±3.02),(15.93±2.89)and(19.93±3.43)respectively,and the comparative analysis showed statistical difference(P<0.05).The positive rates of lymph nodes in the three groups were 18.5%(88/475),19.5%(87/447)and 17.5%(96/548)respectively,and there was no significant statistical difference(P>0.05).The black staining rates of the three groups of lymph nodes were 52.0%(247/475),53.5%(239/447)and 54.6%(299/548)respectively,and there was no significant difference(P>0.05).The metastasis rates of the three groups of black stained lymph nodes were 22.3%(55/247),21.8%(52/239),and 21.4%(64/299)respectively,with no significant statistical difference(P>0.05).Conclusion:1、Nanocarbon lymphatic tracer technology can be used to increase the number of lymph nodes detected during radical gastrectomy(total gastrectomy + Roux-en-Y anastomosis),which can further improve the accuracy of pathological staging.2、Preoperative mucosal injection of Carbon Nanoparticles Suspension Injection in digestive endoscopy can better play the lymphatic tracing effect than intraoperative Serosal injection.3、The use of Carbon Nanoparticles Suspension Injection can reduce the abdominal drainage of patients after radical gastric cancer surgery,and may reduce potential postoperative bleeding and postoperative micro lymphatic leakage.4、The application of carbon nanoparticle tracer technology is safe and feasible.It will not increase the postoperative complications of patients,and has no effect the short-term prognosis of patients either. |
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