Applicationofcarbonnanoparticlestomarklocationsforre-inspectionaftercolonicpolypectomy
《纳米炭标记对结直肠息肉切除术后复查的应用价值》
?SpringerScience+BusinessMediaNewYork
RongWang?YuWang?DazhouLi?LiYu?GangLiu?JunMa?WenWang
王雯教授等
Abstract
BackgroundEndoscopicsurgeryhasbeenanoveltreatmentforcolonpolypsorevenearlycolorectalcancer.However,theexactre-inspectionaftercolonicpolypectomytodetectthescarfrompolypremovalwasdifficulttobeperformed.Inourpreviousstudy,coloncancertattooedwithcarbonnanoparticleswaseasilyfoundduringsurgery.Wespeculatedthatcarbonnanoparticlescouldbeusedinexactre-inspectionaftercolonicpolypectomy.
ObjectiveToevaluatetheefficiencyofcarbonnanoparticlesforre-inspectionaftercolonicpolypectomy.
MethodsTwenty-fourpatientswithprecancerouslesionorearlycolorectalcancerthatunderwentcolonoscopicpolypectomybetweenOctoberandDecemberwereenrolledinthestudy.Participantsweredividedintotwogroups.GroupApatientswereinjectedwithcarbonnanoparticlesbeneaththelesionsites3cm.GroupBpatientswerenottreatedwithnanoparticles.Allpatientsunderwentquarterlycolonoscopies.Oncethecolonoscopewaswithdrawnfromthesitelasttimerecord,thetimespentsearchingforlesionswasrecorded.
ResultsTherewerenosignificantdifferencesbetweengeneralconditionsorlesionpathologybetweenthegroups.ThetimespentsearchingforlesionsinGroupBwasmuchlongerthanthatinGroupA(13.67±8.07vs.1.21±0.39min,P0.).Carbonnanoparticlesmarkedlesionsfor12monthsinsomepatients,andnoadversereactionswerereported.LimitationsItwasasmallsamplestudy.
ConclusionsTattooinglesionsusingcarbonnanoparticlessuspensionsissafe.Thedurabilityofdyeenableslesionstobere-checkedbycolonoscopyorlaparoscopyforupto1year.
摘要
背景内镜切除术已成为结肠息肉甚至早期结直肠癌的新的治疗方法。然而，因内镜切除术后疤痕较微小，结肠镜复查时难以快速精准地找到原切除病灶处是否复发。在我们之前的研究中发现，术前纳米炭标记结直肠癌，可帮助术者在手术中快速找到病灶。于是推测，在结肠息肉切除术后可应用纳米炭作为一种标记方法，利于术后结肠镜的精准复查。
目的评估结肠息肉切除术后利用纳米炭标记对结肠镜复查时快速准确寻找原切除部位的指导价值。
方法本研究纳入了24例于年10月至年12月期间接受结直肠息肉癌前病变及早期结直肠癌内镜下息肉切除术的患者，分成两组。A组患者在病灶部位近端3厘米处粘膜下注入纳米炭，B组患者不行纳米炭标记。所有患者术后均每三个月一次肠镜复查，一旦结肠镜从上次记录的位置撤出，则记录下在寻找病变部位上所花费的时间。
结果两组病人的一般状况和病灶病理没有显著的差异。B组寻找原内镜下切除的病灶所用的时间明显长于A组（13.67±8.07VS.1.21±0.39min,P0.）。部分病人纳米炭标记病灶长达一年以上，没有不良反应的报告。
局限性这是一个小样本研究。
结论采用纳米炭混悬注射液标记病灶是安全的。染色的病变部位的持续时间可以达到一年之久，在结肠镜检查或腹腔镜检查中都能被再次检测到。
Keywords:
CarbonnanoparticlesColonoscopicpolypectomy
Earlycolorectalcancer·Tattoo
关键词：纳米炭·结肠镜息肉切除术·早期结直肠癌·标记
Background
背景
Colonpolypsareonetypeoflesionthatprecedescolorectalcarcinoma.Thankstoprogressingendoscopictechniques,itispossibletoresectlesionscontainingmultiplepolypsorevenearly-stagetumorsthroughthedigestivetractusingendoscopicmucosalresection(EMR)andendoscopicsubmucosaldissection(ESD).Thesetechniquesarealsowidelyappliedintheesophagus[1],stomach[2,3],colon[4],pharynx[5,6],andlarynx[7].Althoughthefutureispromising,thetumorrecurrencerateaftertreatmentwithEMRorESDisashighas10–30%[8].Furthermore,incertaincases,postoperativepathologicdiagnosisofhigh-gradeintraepithelialneoplasia,intramucosal,ormildlysubmucosalinvasivecarcinoma,indicateshigherchanceofrecurrence.Therefore,closereviewsofcolonoscopiesarenecessary.Colonoscopywastheprimarymethodofpost-polypectomysurveillance.However,scarsfrompolypremovalcanbedifficulttodetectduringcolonoscopy.
结肠息肉是结直肠癌前病变的一种类型。由于内镜技术的进步，经消化道内镜下粘膜切除术（EMR）和内镜粘膜下剥离术（ESD）可以切除多发的结肠息肉病灶或早期结直肠肿瘤。这些技术也广泛应用于食管[1]、胃[2,3]、结肠[4]、咽[5,6]和喉[7]。虽然很有前景，但EMR或ESD治疗后肿瘤复发率仍高达10-30%[8]。此外，术后病理诊断为高级别上皮内瘤变、粘膜内癌或轻度粘膜下浸润癌的病例，复发的机率更高。因此，进行详细的肠镜定期复查是必要的。肠镜复查是息肉切除术后监测的首要检测方法。然而，在肠镜复查时，息肉切除后留下的疤痕很难被发现。
Determiningthepreciselocalizationofformallesionsisoftenchallengingduringendoscopyre-checks.Traditionally,distancesfromtheanaledgeareusedtonavigate.However,withdifferentoperatorsanddifferentoperationtimes,theindicatedspotcanvaryupto10cm.AlthoughIndiainktattooingcanlastupto1year,itcancauseadverseevents.Recently,carbonnanoparticleshavebeenusedaslymphnodetracersingastriccancerandcolorectalcancerpatients.Astudyshowedthatpreoperativecolontattooingwithcarbonnanoparticlesmarkedgastricfeaturesfor14days[9],whichwaslongerthanother白癜风初期治疗北京哪家医院治白癜风最好