伊立替康联合亚甲蓝示踪进展期胃癌淋巴结的研究  

Study on lymph node tracing of advanced gastric cancer using irinotecan coupled with methylene blue

作　　者：陈晓鹏[1] 王东[1] 王冠男[1] 胡明华[1] 张卫东[1] 张国政[2] 张帆[3] 

机构地区：[1]皖南医学院弋矶山医院普外科 [2]皖南医学院弋矶山医院消化内科 [3]皖南医学院弋矶山医院病理科

出　　处：《中国临床药理学与治疗学》2011年第7期792-796,共5页Chinese Journal of Clinical Pharmacology and Therapeutics

基　　金：安徽省临床医学重点学科项目基金(05A016)

摘　　要：目的:探讨伊立替康联合亚甲蓝在进展期胃癌根治术中淋巴结示踪的效率及其机制。方法:90例进展期胃癌随机分为非示踪组(31例)、亚甲蓝示踪组(30例)和伊立替康联合亚甲蓝示踪组(29例,简称联合示踪组),其中亚甲蓝示踪组术中用亚甲蓝2 mL分4点于瘤周浆膜下注射,联合示踪组用40 mg伊立替康与2 mL亚甲蓝耦合后分4点注射。3组均用多功能手术解剖器进行刮吸法胃癌根治淋巴结清扫。分别统计各组手术时间、出血量、输血量、清除淋巴结数和术后随访情况。结果:非示踪组、亚甲蓝示踪组和联合示踪组平均手术时间分别为(218±67)、(192±31)和(205±36)min(P>0.05);平均出血量分别为(248±116)、(164±88)和(173±98)mL(P<0.05),输血者平均输血量分别为(457±159)(、489±176)和(467±148)mL(P>0.05);平均每例清除淋巴结数分别为(22±9)、(22±10)和(30±9)枚(P<0.05),平均每例阳性淋巴结数分别为(7±3)、(6±3)和(9±3)枚(P<0.05);3组分别有29、28和28例得到平均3年的随访,肿瘤复发率分别为31.0%(9/29)、32.1%(9/28)和21.4%(6/28)(P>0.05),3年存活率分别为62.1%(18/29)、57.1%(16/28)和78.6%(22/28)(P>0.05)。结论:瘤周浆膜下注射伊立替康与亚甲蓝耦合液可明显提高进展期胃癌患者淋巴结清除效率,且安全简便。其机制可能是耦合液显著延长淋巴结染色和褪色时间,始终存在色觉导向刺激,激发术者进行准确而彻底的淋巴结清扫。AIM： To explore the effectiveness and mechanism of lymph node tracing using irinotecan coupled with methylene blue in radical resection of advanced gastric cancer. METHODS： 90 patients with advanced gastric cancer were randomly divided into the non-tracing group （n=31）, methylene blue tracing group （n= 30） and the combination tracing group （n = 29）. During operation, 2 mL of methylene blue was injected into the peritumoral subserosa at 4 points with microacupuncture needle in methylene blue tracing group, and the couplant of 40 mg of irinotecan and 2 mL methylene blue was injected in combination tracing group. The D2/ D2＋ lymphadenectomy was finished by curettage-aspiration dissection with Peng＇s multifunction operative dissector （PMOD） in all three groups. The operation time, intraoperative hemorrhage quantity, blood transfusion amount, the number of cleared lymph node and postoperative data of follow-up were collected. RESULTS：The average surgery time in three groups were （218 ±67）,（192±31）and （205±36）min（P〉0.05）, respectively. The intraoperative average hemorrhage quantity were（248 ± 116）, （ 164 ± 88） and （173±98）mL（P〈0.05）, and average blood transfusion amount of recipient＇s （457 ± 159）, （489±176）and （467±148） mL（P〉0.05）, respectively. The average numbers of cleared lymph node were （22±9） ,（22±10） and（30±9） （P〈0.05） with positive lymph node（7±3）, （6 ±3）and（9±3）（P〈0.05）, respectively. By an average of 3 years of follow-up, the information of 29, 28 and 28 patients in three groups were collected respectively. The tumor recurrence rates were 31. 0% （9/29）, 32.1G （9/28） and 21.4%（6/28）（P〈0. 05） in three groups while 3-year survival rates were 62.1 % （18/29）, 57.1%（16/28） and 78.6%（22/28） （P〉0.05）, respectively. CONCLUSION： It is not only safe and convenient to inject the couplant of irinotecan and methylene blue into the peritumoral subserosa,

关 键 词：胃癌 淋巴结清扫术 伊立替康 亚甲蓝示踪剂 

分 类 号：R735.2[医药卫生—肿瘤] R969.4[医药卫生—临床医学]