| Objection: Laparoscopic surgery is the main treatment for colorectal carcinoma for its minimal invasion. However, small tumor with no invasive serous layer is difficult to be detected in laparoscopy operation. The aim of this study is to evaluate the safety and efficiency of preoperative endoscopic tattooing with carbon nanoparticles for laparoscopic surgery on colorectal carcinoma.Methods: One hundred patients diagnosed colorectal carcinoma underwent laparoscopic radical resection in Fuzhou General Hospital of Nanjing Command during January 2013 to December 2013 were randomly divided into group A(tattooing) and group B(control). In group A, 50 patients were enrolled, 30 male and 20 female. In group B, 50 patients were enrolled as well, 31 male and 19 female. In group A, a part of patients was endoscopic tattooed during colorectal ESD, the rest were tattooed within 7 days before operation. 0.5ml carbon nanoparticles suspension was used for endoscopic tattooing. For circumferential tumor, the first injection spot were located in oral side beyond the tumor 1-1.5cm away, and the second spots were opposite. Then, withdraw the coloscopy to the anal side and repeat the above steps. For circumferential tumor with obstruction, 4 spots were only injected in anal side 1-1.5cm away the tumor. For not circumferential small tumor, 4 spots were injected around the lesion. Fever, abdominal pain, abdominal distension and hematochezia of endoscopic tattooing complications were recorded after tattooing. Furthermore, red and swollen, exudation, abscess, and intraabdominal adhesion at the injection site and abdominal cavity were also recorded. The following data were extracted: identification time, operation time and blood loss, the mean length of colorectal segment, Median tumor distance to distal resection margin, average duration of hospital stay and hospital cost. According to whether it is invasive to serous layer or not, group A and B was divided into group T1 + T2(group A1, B1) and group T3+T4(group A2, B2), and the data was collected again. All data were analyzed by t test.Results: The longest interval time between endoscopic tattooing and operation was 14 days, and the shortest time was 3 hours before operation. There were no complications of tattooing in all patients in group A. There were number of black dots scattered on peritoneum and mesenterium in 5 cases, while it did not affect to observe the surgical field. Clearly but no exudation and abscess black smudges were observed only on the serosa. Group A had shorter identification time(1.15±0.87 min vs. 10.1±9.8min,p<0.001), operation time(178.58±29.89 min vs. 191.68±30.59 min, p=0.03), the mean length of colorectal segment(13.32±5.96 cm vs. 16.92±7.56 cm,p=0.01). Median tumor distance to distal resection margin( 3.42±1.43 cm vs. 5.39±2.64 cm,p<0.001), average duration of hospital stay( 9.48±2.40 d vs. 12.90±6.88 d,p=0.002), and lower blood loss(98.12±30.23 ml vs. 117.34±39.70 ml,p=0.008), average hospital cost(49799.77±8330.08 Yuan vs. 50623.03±10870.81 Yuan, p=0.672), identification time was significantly shorter in Group A1(1.31±0.91 min vs.21.2±17.1min, p =0.005)and Group A2(1.11±0.87 min vs. 7.3±3.6min, p<0.001), operation time was significantly shorter in Group A1(178.10±28.58 min vs. 204.70±44.90 min, p=0.131) and Group B1(178.70±30.56 min vs. 188.43±25.62 min, p=0.127).Conclusion: Endoscopic tattooing with carbon nanoparticles is simple, safe and permanent. We regard carbon nanoparticles as a promising agent in identification of colorectal carcinoma lesion in laparoscopic resection and that it is worth to be widely introduced for clinical application. |
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