Abstract:
Objective:To explore the application value of nano carbon lymph tracing technique in the radical resection of gallbladder cancer.
Methods:The prospective study was conducted. The clinical data of 120 patients with gallbladder cancer who were admitted to the Henan Provincial People′s Hospital between January 2010 and December 2014 were collected. All the patients were allocated into the experimental group and control group by random number table. For the experimental group, a total of 0.1 mL carbon nanoparticles were injected at 4-6 locations subserously around the cancerous site, radical resection of gallbladder cancer were performed at 15 minutes after injection, and intraoperative stained lymph nodes were used as markers to guide lymphadenectomy. Patients in the control group underwent regular radical resection of gallbladder cancer. Observation indicators: (1) intra- and post- operative situations; (2) number of lymph node sorting; (3) follow-up situations. Follow-up using telephone interview was performed to detect survival of patients up to January 2016. Measurement data with normal distribution were represented as ±s and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were described as M(P25, P75), and comparison between groups was analyzed by the Mann-whitney rank-sum test. Comparisons of count data were analyzed using the chi-square test. Comparison of ordinal data were analyzed by the nonparametric test. The survival curve was drawn by the Kaplan-Meier method. Survival analysis was done using the Log-rank test.
Results: One hundred and twenty patients were screened for eligibility, and were allocated into the experimental group and control group, 60 in each group. (1) Intra- and postoperative situations: operation time, volume of intraoperative blood loss and duration of postoperative hospital stay were respectively (164±51)minutes, (200±98)mL, (13±4)days in the experimental group and (178±52)minutes, (225±98)mL,(14±5)days in the control group, with no statistically significant difference between groups (t=-1.50, -1.42, -1.03, P>0.05). (2) Comparison of lymph node sorting: overall number of lymph node sorting, overall number of positive lymph node sorting, number of N2 station lymph node sorting and number of positive N2 station lymph node sorting were respectively 13.0 (12.0, 15.0), 8.0 (5.0, 9.0), 7.0 (5.0, 8.0), 3.0 (2.0, 4.0) in the experimental group and 10.0 (8.0, 12.0), 5.0 (4.0, 6.0), 5.0 (3.0, 5.0), 1.0 (1.0, 2.0) in the control group, with statistically significant differences between groups (Z=-5.51, -4.37, -6.24, -6.18, P<0.05). Number of N1 station lymph node sorting and number of positive N1 station lymph node sorting were respectively 6.0 (5.0, 6.0), 4.0 (3.0, 5.0) in the experimental group and 6.0 (4.0, 7.0), 4.0 (2.0, 5.0) in the control group, with no statistically significant difference between groups (Z=-0.82, -1.34, P>0.05). Overall number of lymph node sorting, overall number of positive lymph node sorting, number of N2 station lymph node sorting and number of positive N2 station lymph node sorting were respectively 5.0 (4.8, 6.3), 0(0, 0.8), 2.0 (1.0, 3.3), 0(0, 0.5) in patients with stage Ⅱ of the experimental group and 3.0 (2.0, 4.3), 0 (0, 0), 0 (0, 1.3), 0(0, 0) in patients with stage Ⅱ of the control group, with statistically significant differences between groups (Z=-2.96, -2.02, -2.38, -2.01, P<0.05). Number of N1 station lymph node sorting and number of positive N1 station lymph node sorting were respectively 3.0 (3.0, 3.3), 0 (0, 0.3) in patients with stage Ⅱ of the experimental group and 3.0 (2.0, 3.0), 0 (0, 0) in patients with stage Ⅱ of the control group, with no statistically significant difference between groups (Z=-1.18, -1.81, P>0.05). Overall number of lymph node sorting, overall number of positive lymph node sorting, number of N2 station lymph node sorting and number of positive N2 station lymph node sorting were respectively 13.0 (12.0, 15.0), 7.0 (5.0, 8.0), 7.0 (5.0, 8.0), 3.0 (2.0, 4.0) in patients with stage Ⅲ of the experimental group and 10.0 (9.0, 12.0), 5.0 (4.0, 6.0), 5.0 (4.0, 5.0), 2.0 (1.0, 2.0) in patients with stage Ⅲ of the control group, with statistically significant differences between groups (Z=-4.80, -3.43, -5.25, -4.76, P<0.05). Number of N1 station lymph node sorting and number of positive N1 station lymph node sorting were respectively 6.0 (6.0, 8.0), 4.0 (3.0, 5.0) in patients with stage Ⅲ of the experimental group and 6.0 (5.0, 7.0), 4.0 (3.0, 4.5) in patients with stage Ⅲ of the control group, with no statistically significant difference between groups (Z=-1.52, -1.16, P>0.05). Overall number of lymph node sorting, overall number of positive lymph node sorting, number of N2 station lymph node sorting and number of positive N2 station lymph node sorting were respectively 14.0 (13.0, 15.0), 9.0 (8.0, 10.0), 8.0 (7.5, 8.0), 4.0 (4.0, 5.0) in patients with stage Ⅳa of the experimental group and 11.0 (10.0, 13.0), 6.0 (4.0, 8.0), 5.0 (5.0, 6.0), 2.0 (1.0, 2.0) in patients with stage Ⅳa of the control group, with statistically significant differences between groups (Z=-3.47, -3.25, -4.02, -3.92, P<0.05). Number of N1 station lymph node sorting and number of positive N1 station lymph node sorting were respectively 6.0 (5.5, 6.0), 5.0 (4.0, 5.0) in patients with stage Ⅳa of the experimental group and 6.0 (5.0, 7.0), 4.0 (3.0, 6.0) in patients with stage Ⅳa of the control group, with no statistically significant difference between groups (Z=-0.14, -0.45, P>0.05). (3) Follow-up situations: 120 patients were followed up for 12-60 months, with a median time of 28 months. The postoperative overall survival time was (45.7±2.3)months in the experimental group and (36.5±2.4)months in the control group, with a statistically significant difference between groups (X
2=8.32, P<0.05). The postoperative overall survival time was (54.5±3.0) months in patients with stage Ⅱ of the experimental group and (39.6±0.9)months in patients with stage Ⅱ of the control group, with no statistically significant difference between groups (X
2=3.77, P>0.05). The postoperative overall survival time was (42.2±2.7)months in patients with stage Ⅲ of the experimental group and (35.0±3.0)months in patients with stage Ⅲ of the control group, with a statistically significant difference between groups (X
2=4.12, P<0.05). The postoperative overall survival time was (37.7±2.5)months in patients with stage Ⅳa of the experimental group and (27.0±3.1)months in patients with stage Ⅳa of the control group, with a statistically significant difference between groups (X
2=4.14, P<0.05).
Conclusion:The nano carbon lymph tracing technique in the radical resection of gallbladder cancer can guide precise operation, increase the numbers of overall and positive lymph nodes sorting, and extend postoperative overall survival time.
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