Li Yingru, Li Fei, Zhang Yuru, Liu Liting
Department of General Surgery, Beijing Anorectal Hospital, Beijing, 100230, China.
Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.
Eur J Med Res. 2025 Jun 5;30(1):457. doi: 10.1186/s40001-025-02721-1.
This study aims to investigate the application strategy of "single point-point pressure method" and multi-point injection techniques for carbon nanoparticle injection in laparoscopic radical resection of rectal cancer. The focus is on evaluating the efficacy and efficiency of both methods in sentinel lymph node mapping and tumor localization.
A prospective analysis was conducted on a total of 119 rectal cancer cases treated our center from January 2020 to December 2021. The cases were divided into two groups: multi-point group and single-point group. In the multi-point group, multiple points of 1:1 diluted nano-carbon suspension were injected into the submucosa around the lesions. In the single-spot group, the tumor lesions were identified using electronic colonoscopy, followed by manual pressure applied to the corresponding abdominal wall. A single point of the stock solution of nano-carbon suspension was injected into the submucosa around the lesions upon observing the external pressure "bouncing sign" under the microscope.
No significant differences were observed between the multi-point group and the single-point group in terms of the number of detected lymph nodes, lesion location, distal resection margin (time to locate the tumor), carbon nanoparticles injection spatter event, operation time for middle and high rectal cancer, intraoperative blood loss, and postoperative exhaust time (P > 0.05). However, the injection time of nano-carbon and operation time for low rectal cancer were significantly shorter in the single point group, with statistically significant differences observed between the two groups (P < 0.05).
Identifying the distal resection margin clinically contributes to reducing operation time, simplifying surgical procedures, and enhancing efficiency. Sentinel lymph node mapping is crucial in colorectal cancer as it helps in accurate staging and treatment planning. This study aligns with previous research highlighting the effectiveness of carbon nanoparticles in improving lymph node detection and reducing operative time. In addition, this study contributes to the literature by demonstrating the efficiency of the "single point-point pressure method" in laparoscopic radical resection of rectal cancer, offering a simpler and faster alternative to multi-point injection techniques.
本研究旨在探讨“单点按压法”及多点注射技术在腹腔镜直肠癌根治术中碳纳米颗粒注射的应用策略。重点是评估这两种方法在前哨淋巴结定位和肿瘤定位中的疗效和效率。
对2020年1月至2021年12月在本中心接受治疗的119例直肠癌病例进行前瞻性分析。病例分为两组：多点组和单点组。在多点组中，将1:1稀释的纳米碳悬浮液多点注射到病变周围的黏膜下层。在单点组中，先用电子结肠镜识别肿瘤病变，然后对相应的腹壁施加手动压力。在显微镜下观察到外部压力“弹跳征”后，将纳米碳悬浮液原液单点注射到病变周围的黏膜下层。
多点组和单点组在检测到的淋巴结数量、病变位置、远端切缘（肿瘤定位时间）、碳纳米颗粒注射飞溅事件、中高位直肠癌手术时间、术中出血量和术后排气时间方面均无显著差异（P＞0.05）。然而，单点组纳米碳注射时间和低位直肠癌手术时间明显较短，两组间差异有统计学意义（P＜0.05）。
临床确定远端切缘有助于缩短手术时间、简化手术操作并提高效率。前哨淋巴结定位在结直肠癌中至关重要，因为它有助于准确分期和治疗规划。本研究与之前强调碳纳米颗粒在改善淋巴结检测和缩短手术时间方面有效性的研究一致。此外，本研究通过证明“单点按压法”在腹腔镜直肠癌根治术中的效率，为文献做出了贡献，为多点注射技术提供了一种更简单、更快的替代方法。
