双重染色标记胃癌前哨淋巴结的临床应用研究

Clinical application study of sentinel lymph node of double-staining mark in gastric cancer

目的探讨胃癌前哨淋巴结(SLN)术中标记的方法,评估SLN预测胃癌区域淋巴结转移状态的价值及其指导胃癌淋巴结清扫范围的临床意义。方法 32例胃癌患者,行标准胃癌根治术,在原发癌灶周围选取2、4、6、8、10、12点共6点,于2、6、10和4、8、12点处浆膜下分别注射专利蓝,吲哚菁绿0.8mL,找到染色的淋巴结(即SLN),术后收集非前哨淋巴结。行常规HE染色和CK20、CEA免疫组化染色,分别计算前哨淋巴结诊断胃癌淋巴结转移状态的准确性、敏感性、阴性预测值和假阴性率。结果双重染色标记胃癌SLN假阴性率与单一染料假阴性率分别为4.55%、18.18%、22.72%,差异有统计学意义(P<0.05)。结论双重染色标记示踪胃癌前哨淋巴结是一种简单经济的方法,能准确预测胃癌周围淋巴结的转移状态,可用于指导胃癌的淋巴结清扫范围。

Objective To study the method of sentinel lymph nodes （SLN）marking in patients with gastric cancer and assess its potential role in determining the rational extent of lymphadenectomy in gastric cancer surgery.Methods Thirty-two cases of gastric cancer patients with standard radical gastrectomy,around the primary foci 2,4,6,8,10,12 select six points,at the point of 2,6,10 and 4,8,12 were injected subserous patent blue and indocyanine green 0.8ml and find staining of the lymph node （SLN）,Non-sentinel lymph nodes were collected after the operation.All resected nodes were examined postoperatively by routine HE stain and those negative SLNs were examined with further cytokeratin immunohistochemistical staining.The diagnostic accuracy,sensitivity,negative predictive value and false-negative rate of regional lymph node statuson the basis of SLN status were calculated respectively.Results False-negative rate of SLN by double-staining dye marker of gastric cancer and a single stanining dye were,respectively,4.55%,18.18%,22.72%,the difference was statistically significant （P0.05）.Conclusion Double-staining sentinel lymph node of gastric cancer tracer tag is a simple and economical methods that can accurately predict lymph node metastasis of gastric cancer around the state,can be used to guide the scope of lymph node dissection for gastric cancer.