前哨淋巴结导航手术在早期胃癌治疗中的初步应用  

Preliminary experiences of application of sentinel lymph node navigation technique in early gastric cancer

作　　者：程黎阳[1] 谢正勇[1] 戴观荣[1] 赵为国[1] 

机构地区：[1]广州军区广州总医院普通外科,510010

出　　处：《中华外科杂志》2008年第14期1076-1079,共4页Chinese Journal of Surgery

基　　金：广东省自然科学基金资助项目（03204）

摘　　要：目的探讨早期胃癌（EGC）在前哨淋巴结（SLN）导航下行缩小手术的可行性和临床意义。方法将确诊的39例EGC患者随机分为SLN导航组（20例）和常规手术组（19例）。导航组联用专利蓝和‰Tc标记的硫胶体进行SLN活检，对17例SLN术中冰冻病理阴性的EGC行缩小的Do．D1病灶局部切除或胃部分切除术，余3例因SLN阳性行常规D2根治术。传统手术组19例均行D2根治术。计算SLN诊断EGC淋巴结转移情况的准确率和假阴性率，比较两组的手术情况、术后康复和1、3年无瘤生存率。结果SLN检测成功率为100％（20／20），平均检出SLN2．2个／例，由SLN诊断胃癌区域淋巴结转移状况的准确性为95％（19／20），假阴性率为5％（1／20）。与22例传统手术相比，17例缩小手术在不降低术后无瘤生存率的前提下，显著缩短了手术时间，减少了术中出血量，加快了术后康复的速度，减少了手术并发症。结论SLN活检可准确判断EGC的区域淋巴结转移情况，对SLN转移阴性的EGC病例行缩小的限制性手术既可保证根治效果又能获得微创益处。Objective To investigate the feasibility and clinical significance of sentinel lymph node （SLN） navigation limited surgery in early gastric cancer（EGC）. Methods Thirty-nine patients confirmed with EGC between January 2002 and December 2006 were randomly divided into tailored surgery group （20 cases） and conventional surgery group （19 cases）. By combining the mapping agents of ^99mTc labeled sulfur colloid solution and blue violet, SLN biopsy was conducted in tailored surgery group, in which a limited gastric resection with D0-D1 lymphadenectomy was performed in 17 cases with negative SLN examined by routine HE staining during operation; standard radical gastrectomy with lymphadenectomy （D2） was conducted in the other 3 cases with positive SLN and in all the cases of conventional surgery group. The diagnostic accuracy and false-negative rate of SLN status were calculated respectively. The operation outcome and postoperative complication and survival rate were compared between the two groups. Results SLNs were detected in all 20 patients with a successful detection rate of 100% in tailored surgery group. The number of detected SLNs ranged from 1 to 3, with a mean of 2.2 per case. The diagnostic accuracy and false-negative rate was 95% and 5%, respectively. The hospital stay and recovery time of gastrointestinal functions in patients undergoing limited surgery were significantly shorter than in conventional surgery group and with similar postoperative survival and less complications. Conclusions SLN biopsy may provide an accurate diagnostic procedure for detecting lymph node metastasis in EGC. Patients with node-negative EGC receiving limited surgery are likely to benefit from minimally invasive approach with the similar survival as standard radical surgery.

关 键 词：胃肿瘤 前哨淋巴结活组织检查 外科手术 

分 类 号：R735.2[医药卫生—肿瘤]