早期胃癌吲哚菁绿荧光腹腔镜前哨淋巴结导航手术的可行性评价  

The safety and feasibility of laparoscopic indocyanine green fluorescence mapping during sentinel node navigational surgery for early gastric cancer

作　　者：郭春光 李泽锋 王童博 张晓杰 孙崇源 任虎 刘勇 窦利州 贺舜 张月明 王贵齐 赵东兵 Guo Chunguang;Li Zefeng;Wang Tongbo;Zhang Xiaojie;Sun Chongyuan;Ren Hu;Liu Yong;Dou Lizhou;He Shun;Zhang Yueming;Wang Guiqi;Zhao Dongbing(Department of Pancreatic and Gastric Surgical Oncology,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China;Department of Endoscopy,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China)

机构地区：[1]国家癌症中心、国家肿瘤临床医学研究中心、中国医学科学院北京协和医学院肿瘤医院胰胃外科,北京100021 [2]国家癌症中心、国家肿瘤临床医学研究中心、中国医学科学院北京协和医学院肿瘤医院内镜科,北京100021

出　　处：《中华普通外科杂志》2024年第10期770-775,共6页Chinese Journal of General Surgery

基　　金：中国医学科学院医学与健康科技创新工程项目(2021-I2M-1-061)。

摘　　要：目的评价早期胃癌吲哚菁绿(ICG)荧光腹腔镜前哨淋巴结导航手术的安全性和可行性。方法2019至2021年北京协和医学院肿瘤医院总计18例患者成功施行ICG荧光腹腔镜前哨淋巴结导航手术。选择肿瘤直径<4cm早期胃癌手术病例,在胃镜下病变周围4点黏膜下注射0.5 ml ICG(2.5 mg/ml),ICG荧光腹腔镜下切除前哨淋巴引流区送冰冻病理检查,根据病理结果行胃癌根治术或单纯前哨淋巴结活检。结果18例患者中16例肿瘤位于胃中下部,中位肿瘤直径2 cm,5例可见脉管瘤栓,3例可见神经侵犯。T分期包括2例Tis,5例T1a和11例T1b。每例中位活检2(1~5)个前哨淋巴结引流区,包含6(2~13)枚淋巴结,其中6(1~13)枚染色淋巴结和1(0~5)枚非染色淋巴结。18例患者中4例(22%)发现淋巴结转移,转移淋巴结均位于前哨淋巴结引流区。前哨淋巴结导航手术敏感性和准确率均为100%。中位随访58.3个月(0.3~59.9个月),所有患者均未见肿瘤复发及转移。结论ICG荧光腹腔镜能够准确探测早期胃癌前哨淋巴结引流区。Objective To evaluate the safety and feasibility of the laparoscopic indocyanine green(ICG)fluorescence imaging during the sentinel node navigational surgery for the early gastric cancer.Methods Patients with<4 cm early gastric cancer were chosen.0.5 ml ICG(2.5 mg/ml)was preoperatively injected into submucosa around the lesion in four points by the endoscopy.The sentinel lymph node basin including the stained tissue and lymph node(LN)were completely resected guided by the fluorescence mapping under ICG laparoscopy.The specimen was inspected by frozen pathology section.The radical gastrectomy was dependent on the pathology result.Result Between 2019 and 2021,a total of 18 patients were included in the final analysis.Most tumors(16/18)located in the middle or distal stomach.Median tumor size was 2.0 cm.Lymph vessel invasion was revealed in five cases and perineural invasion in three cases.According to AJCC tumor grading system,tumor depth was classified as Tis in 2 cases,T1a in 5 cases and T1b in 11 cases.Lymph node metastasis(LNM)was revealed in four patients(4/18,22%).Median sentinel lymph node basins per patient were 2(range,1-5).An average 6(range,2-13)LNs were harvested in each case,including 6(1-13)ICG stained LNs and 1(0-5)non stained LNs.All of four LNM patients were detected by sentinel node navigational surgery.The rate of the sensitivity and accuracy were 100%and 100%,respectively.The median follow-up for the entire group was 58.3 months(0.3-59.9 months),with no recurrence or metastasis observed in any patient.Conclusion The sensitivity and accuracy of the laparoscopic indocyanine green fluorescence imaging during the sentinel node navigational surgery were satisfactory.

关 键 词：胃肿瘤 前哨淋巴结 吲哚菁绿 腹腔镜 

分 类 号：R735.2[医药卫生—肿瘤]