胃癌前哨淋巴结活检的时间探讨  被引量:1

Study on the appropriate time of the sentinel lymph node biopsy in gastric carcinoma

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作  者:张永茂[1] 姜淮芜[2] 吴宸[2] 肖仕明[2] 胡恒清[2] 肖琳[2] 何运胜[2] 张华[2] 

机构地区:[1]四川中医药高等专科学校外科学教研室,四川绵阳621000 [2]川北医学院第二附属医院普外二科绵阳市消化中心消化外科,四川绵阳621000

出  处:《现代医药卫生》2008年第18期2704-2706,共3页Journal of Modern Medicine & Health

基  金:四川省卫生厅科学研究基金资助项目(编号:050182)

摘  要:目的:探讨进展期胃癌(AGC)手术中亚甲蓝示踪前哨淋巴结活检(SLNB)的最佳时间。方法:对2003年2月~2007年3月收治的AGC手术中,将亚甲蓝-丝裂霉素溶液在癌灶周边浆膜侧分3~5点浆膜下注射。分别在5~10 min及2~4.9 min两个时间段切取SLN进行病理学检查。如果常规HE染色病理检查阴性,则加作免疫组化检查。比较两组SLN的数量,阳性发现及其与分站的关系。将入组的55例AGC按SLNB时间分为SLNB一组(5~10 min切取SLN)及SLNB二组(2~4.9 min切取SLN)。结果:(1)SLNB一组30例均有SLN发现,共找到SLN78枚,平均每例2.6枚,SLNB二组25例有15例发现SLN,共找到SLN16枚,平均每例0.64枚,P<0.05。(2)SLNB一组78枚SLN中肿瘤转移共66枚,7枚免疫组化检查发现,淋巴结转移阳性率84.6%。30例中有28例SLN转移,转移病例阳性率93.3%。SLNB二组16枚SLN中肿瘤转移共13枚,淋巴结转移阳性率81.3%。25例中有11例SLN转移,转移病例阳性率44%,两组转移SLN比较P>0.05,转移病例比较P<0.01。(3)SLN与淋巴结站组的关系分别是SLNB一组N1 60枚(76.9%)、N2 15枚(19.2%)、N3 3枚(3.8%),转移SLN数目与淋巴结分站的关系依此为N1 58枚(87.8%)、N2 5枚(7.5%)、N3 3枚(4.5%),SLNB二组1 15枚(93.7%)、N2 1枚(6.3%)、N3 0枚,转移SLN数目与淋巴结分站的关系依此为N1 2枚(92.3%)、N2 1枚(7.7%)、N3 0枚,组间比较P>0.05、组内比较P<0.05。结论:(1)用亚甲蓝-丝裂霉素溶液作为示踪剂进行SLNB,5~10 min切取的SLN数目多、阳性率高,对手术的指导价值大;(2)当手术中SLN出现在第三站时,及时改行扩大手术可望提高手术根治的效果。Objective:To explore the appropriate time of the sentinel lymph node (SLN) biopsy in AGC surgery with methylene blue tracing.Methods:We injected the solution of methylene blue-mitomycin in the serosa around the focus of the cancer for 3-5 points in all AGC surgery during 2003.2-2007.3.The SLNs were cut during the two time stages (5-10 mins and 2-4.9 mins respectively),and carried on the pathology inspection.If the conventional HE staining was negative,the immuno-histochemistry was added.We Compared the SLNs quantities,the positive rate of the two groups to learn the relation between the positive rate with substation.The 55 cases of AGC were divided into two groups according to the hospitalization time,the SLNB was done during 5-10 mins in the first group (group Ⅰ),and during 2-4.groins in the second group(group Ⅱ).Results: (1)The SLNs were found in 30 patients of the group Ⅰ(total 78 grains, average 2.6 grains each patient). The SLNs were found in 15 patients of the group Ⅱ (total 16 grains,average 0.64 grains each patient) (The average of the SLNS,group Ⅰ vs group Ⅱ,P〈0.05).(2)66 grains had the tumor metastasis in all 78 grains of group 1,7 grains were discovered by the immunohistochemistry,the positive rate of the lymph node metastasis was 84.6%(66/78).28 patients had lymph node metastasis in group Ⅰ, the positive rate of metastasis was 93.3%(28/30),13 grains had the tumor metastasis in all 16 grains of group Ⅱ,the positive rate of the lymph node metastasis was 81.3%(13/16).11 patients had metastasis lymph node in group Ⅱ,the positive rate of metastasis patients was 44%(11/25)(the positive rate of the lymph node metastasis,group Ⅰ vs group Ⅱ ,P〉0.05; the positive rate of metastasis patients,group Ⅰ vs group Ⅱ,P〈0.01),(3)In group 1,60 SLNs were found in N1 (60/78,76.9%),15 SLNs were found in N2(15/78,19.2%),3 SLNs were found in N3(3/78,3.8%),58 metastasis SLNs in N1(58/66,87.8%),5 metastasis SLNs in

关 键 词:进展期胃癌 前哨淋巴结 活检 时间 

分 类 号:R73[医药卫生—肿瘤]

 

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