阮剑敏 1曾宝玲 2刘婕 1林丽君 1张敏 1欧阳霞3
作者信息
- 1. 中山大学孙逸仙纪念医院护理部,广州 510120||中山大学孙逸仙纪念医院消化内镜中心,广州 510120
- 2. 中山大学孙逸仙纪念医院护理部,广州 510120||中山大学孙逸仙纪念医院胃肠外科,广州 510120
- 3. 中山大学孙逸仙纪念医院护理部,广州 510120||中山大学孙逸仙纪念医院护理教研室,广州 510120
- 折叠
摘要
Abstract
Objective To establish a modified management protocol for endoscopic localization using submucosal nanocarbon injection,assess the interval from endoscopic localization with a nanocarbon tracer to surgery,and evaluate the association between the"three-stage,six-step"modified protocol and clinical indicators,to provide a reference for perioperative management of precise localization of gastroin-testinal tumors.Methods A retrospective study was conducted among patients who underwent preopera-tive endoscopic localization by submucosal tracer injection at our digestive endoscopy center from October 2023 to April 2026.Patients were divided into three groups according to tracer type and management protocol:Group G1(methylene blue with the conventional protocol,n=26),Group G2(nanocarbon with the conventional protocol,n=20),and Group G3(nanocarbon with the modified protocol,n=21).The interval from endoscopic localization to surgery,operative duration,postoperative hospital stay,time to first flatus,time to enteral nutrition resumption,number of lymph nodes dissected,number of positive lymph nodes,and lymph node dissection adequacy rate(≥12 nodes for colorectal cancer,≥16 nodes for gastric cancer)were compared among the three groups.Results Significant differences were observed among the three groups in the interval from endoscopic localization to surgery(P<0.001),post-operative hospital stay(P=0.013),number of lymph nodes dissected(P=0.008),and lymph node dis-section adequacy rate(P=0.045),while no significant differences were found in operative duration,time to first flatus,or time to enteral nutrition resumption(all P>0.05).Pairwise comparisons with Bonferroni correction showed that:under the same conventional management protocol(G1 vs.G2),the nanocarbon group(G2)had a longer interval from endoscopic localization to surgery than the methylene blue group(G1)[median 22.29(18.04,27.27)h vs.3.74(3.15,5.47)h,Z=-5.874,P<0.001];with the same nanocarbon tracer(G2 vs.G3),the modified management group(G3)had a shorter postoperative hospi-tal stay than G2[6.00(6.00,7.50)d vs.8.00(7.00,9.00)d,Z=-2.869,P=0.012];the lymph node dissection adequacy rate in G3 was 20.5 percentage points higher than that in G2[90.5%(19/21)vs.70.0%(14/20),Yates' corrected χ2=1.586,P=0.208].Although the difference was not statistically significant after Yates' correction,the magnitude of the increase suggested potential clinical relevance.Conclusion Nanocarbon tracer was associated with a longer observed interval from endoscopic localiza-tion to surgery compared with methylene blue,a finding consistent with the established evidence of its prolonged tissue retention.The"three-stage,six-step"modified management protocol was associated with a shorter postoperative hospital stay and showed a trend toward improved lymph node dissection quality.The protocol is well-structured and reproducible;however,its safety and long-term outcomes require further validation in prospective studies.关键词
胃肠肿瘤/纳米炭/内镜定位/淋巴结清扫/围手术期管理Key words
gastrointestinal tumors/nanocarbon/endoscopic localization/lymph node dissection/perioperative management分类
医药卫生
