胃窦癌前哨淋巴结及淋巴结转移规律的临床研究

Clinical study of sentinel lymph node and lymph node metastasis in gastric antral cancer

目的研究胃窦癌前哨淋巴结分布规律并探讨其在早期胃窦癌手术治疗中的临床应用价值。方法在对病人行胃癌手术前先进行前哨淋巴结活检(即开腹后在原发灶周围注射亚甲蓝,切除在5min之内被染色的所有淋巴结),然后行胃切除手术和扩大淋巴结切除术。结果本组病人30例有29例均找到SLN(成功率为99%),均为幽门下淋巴结(第六组淋巴结),并对淋巴结转移规律进行研究,为胃窦癌手术淋巴结清扫范围提供参考依据。结论对于SLN阴性及早期胃窦癌施行D1或D1+切除可获得A级根治度,并通过亚甲蓝术中间接淋巴染色,可提高胃癌根治术中淋巴结和阳性淋巴结清除的绝对数,避免不必要的标准手术,减少并发症。

Objective To explore the distribution of sentinel lymph node （SLN） and discuss the clinical applied value in early gastric antral cancer. Methods These patients were detected by sentinel lymph node biopsy （ Methylene blue was injected around the primary tumor, then we eliminated all of the lymph nodes which were stained in 5 minutes）, before gastrectomy and extended lymph node dissection. Results SLN were detectable in 29 of 30 patients with the successful rate being 99%, and all SLN were subpyloric lymph nodes （ the sixth group lymph node）. In the patients with gastric antral cancer SLN can clearly predict the metastasis status of lymph nodes, it provides reference data for lymph node dissection. Conclusion The patients with negative SLN and early gastric antral cancer should be performed gastrectomy with D1 or D1 ＊ lymphadenectomy, so the patients can effect a radical cure of A level. It increases the veracity of clinical stage in patients of gastric antral cancer through detection of sentinel lymph nodes by Methylene blue staining, consequently avoids unnecessary standard operation, decreases the rate of operative complication.