引用文本：万仁辉, 刘辉, 张琳, 等. 术前肠镜下注射纳米碳淋巴示踪剂指导结直肠癌根治术中淋巴结清扫的应用价值[J/CD]. 消化肿瘤杂志（电子版）, 2025, 17(1):65-71.

作者：万仁辉1，刘辉1，张琳1，温宜清1，闵英运1，林晓东1，覃熙虎1，乐志青1，刘硕1，汪晋宁2

单位：1.东莞市横沥医院 普外科，广东 东莞 523460；2.中山大学附属第六医院  结直肠外科，广东 广州 510655

Authors：Wan Renhui1, Liu Hui1, Zhang Lin1, Wen Yiqing1, Min Yingyun1, Lin Xiaodong1, Qin Xihu1, Le Zhiqing1, Liu Shuo1, Wang Jinning2

Unit：1. Department of General Surgery, Hengli Hospital, Dongguan 523460, Guangdong, China；2. Department of Colorectal Surgery, Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou 510655, Guangdong, China

摘要：

目的 探讨术前肠镜下注射纳米碳淋巴示踪剂指导结直肠癌根治术中淋巴结清扫的应用价值。方法 本研究采用前瞻性、随机、对照临床研究设计，自2022年5月1日至2024年12月31日共计纳入就诊于东莞市横沥医院符合研究标准的100例术前临床分期为Ⅱ~Ⅲ期的结直肠癌患者，采用中央随机方法按1∶1将患者随机分到试验组与对照组，每组各50例。所有患者术前均经多学科诊疗决定治疗方案，试验组患者接受术前肠镜下注射纳米碳淋巴示踪剂来指导结直肠癌根治术中的淋巴结清扫；对照组患者按照常规方法进行结直肠癌根治术。手术按照全结肠系膜切除术或者是全直肠系膜切除术原则进行。术后大体标本经手术组的医生解剖并详细记录每站淋巴结数量、大小、染色情况，同时将其送病理检查以明确淋巴结转移情况。研究者记录围手术期相关数据，包括：术中并发症、手术时间、术中出血量、术后并发症、术后肛门早期排气时间、术后住院天数等，并比较两组临床指标之间的差异。结果 两组患者一般临床资料差异无统计学意义（均P>0.05）。所有患者均顺利进行手术治疗，无围手术期死亡病例，无严重不良事件报告。试验组平均淋巴结清扫数目[（26.1±7.9）枚比（20.9±9.9）枚，P=0.006]、获检＜5 mm淋巴结数目[（4.9±0.5）枚比（3.1±0.5）枚，P=0.007]均优于对照组。试验组和对照组的手术时间、获检阳性淋巴结数目、术中出血量、肛门早期排气时间、术后住院时间差异均无统计学意义（均P>0.05）。两组术后30 d内的并发症发生率差异无统计学意义（均P>0.05）。术后两组最常见的非手术并发症为肺部感染（试验组12.0%比对照组8.0%，P=0.505），其中，试验组有1例术后吻合口漏患者和1例小肠梗阻患者再次行手术，1例患者因手术部位感染再次入院。两组均无腹腔出血和吻合口出血病例。结论 术前肠镜下注射纳米碳淋巴示踪剂指导结直肠癌根治术中的淋巴结清扫是安全可行的，能够提高总体淋巴结的检出率，尤其是<5 mm淋巴结的检出率能明显提高，可能有助于减少病理分期的偏移。

关键词：结直肠癌；内镜；纳米碳；淋巴转移

Abstract：

Objective To explore the application value of preoperative injection of nanocarbon lymphatic tracer under colonoscopy to guide lymph node dissection during radical resection of colorectal cancer. Method This study adopted a prospective, randomized, controlled clinical trial design. This study had included a total of 100 preoperative clinical stage Ⅱ-Ⅲ colorectal cancer patients at Hengli Hospital who met the research criteria from May 1, 2022 to December 31, 2024. The patients were randomly divided into the experimental group and the control group by 1∶1 ratio using a centralized randomization method, with 50 cases in each group. All patients underwent multidisciplinary treatment before surgery to determine the treatment plan. The experimental group received preoperative injection of nanocarbon lymphatic tracer under colonoscopy to guide lymph node dissection during radical resection of colorectal cancer. The control group underwent routine radical resection for colorectal cancer. The surgery is performed according to the principles of total mesocolectomy or total mesorectal excision. The postoperative gross specimen was dissected by the surgical team and the number, size, and staining of lymph nodes at each station were recorded in detail. At the same time, it was sent for pathological examination to clarify the lymph node metastasis. Researchers record perioperative related data, including intraoperative complications, surgical time, intraoperative blood loss, postoperative complications, postoperative early anal exhaust time, postoperative hospital stay, and other indicators. The differences of clinical indicators between two groups were compared. Result There was no statistically significant difference in general clinical data between the two groups (all P>0.05). All patients underwent surgical treatment smoothly, with no perioperative deaths or reports of serious adverse events. The average number of lymph node dissections [ (26.1 ± 7.9) vs. (20.9 ± 9.9), P=0.006] and the number of detected lymph nodes<5 mm [ (4.9 ± 0.5) vs. (3.1 ± 0.5), P=0.007] in the experimental group were better than those in the control group. There were no statistically significant differences in the surgical time, number of positive lymph nodes detected, intraoperative blood loss, early anal exhaust time, and postoperative hospital stay between the two groups (all P>0.05). There was no statistically significant difference in the incidence of complications within 30 days after surgery between the two groups (all P>0.05). The most common non-surgical complication after surgery in the two groups was pulmonary infection (12.0% in the experimental group vs. 8.0% in the control group, P=0.505). In the experimental group, one patient with anastomotic leakage and one patient with small intestinal obstruction underwent surgery again, and one patient was readmitted due to surgical site infection. There were no cases of abdominal bleeding or anastomotic bleeding in either group. Conclusion Preoperative injection of nanocarbon lymphatic tracer under colonoscopy to guide lymph node dissection during radical resection of colorectal cancer is safe and feasible, and can improve the overall lymph node detection rate, especially the detection rate of<5 mm lymph nodes, which can be significantly improved and may help reduce pathological staging deviation.

Key words：Colorectal cancer; Endoscopy; Nanocarbon; Lymph node metastasis

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