进展期胃癌以术中淋巴显影为指导的D2根治术

Intraoperative lymphatic mapping guided D2 lymphadenectomy in advanced gastric cancer

目的比较进展期胃癌在D2基础上以术中淋巴显影为指导的个体化清扫与常规D2根治术的淋巴结清扫效果。方法20例进展期胃癌患者术中在肿瘤周围注射纳米炭混悬液者为纳米炭组，在D2根治术的基础上以黑染淋巴结为指导进行个体化清扫。21例常规行D2根治术的进展期胃癌为对照组，比较两组清扫淋巴结的数目及淋巴结转移情况、纳米炭组淋巴结黑染情况，并观察其副作用及并发症。结果纳米炭组平均清扫淋巴结（35．1±13．4）枚／例，高于对照组的（26．2±7．8）枚／例，两者相比差异有统计学意义（t=2．126，P=0．034），主要体现在N2、N3淋巴结的清扫；纳米炭组淋巴结黑染率为52．7％，黑染淋巴结中发生转移的阳性率（27．6％）高于未黑染淋巴结（10．8％）及对照组（16．9％），差异均有统计学意义（X^=6．034，P=0．016；X^2=5．142，P=0．023）；纳米炭组术后1例发生输入襻梗阻。结论在D2根治术的基础上以术中淋巴显影技术为指导对进展期胃癌进行淋巴结清扫，能增加淋巴结清扫的效率。

Objective To compare the number of lymph node dissected by intraoperative lymphatic mapping guided D2 gastreetomy and that by standard D2 gastreetomy plus lymphadenectomy in patients of advanced gastric cancer. Methods In this study 20 advanced gastric cancer cases received intraoperative peritumor injection of carbon nanoparticles suspension （ group 1 ） and D2 lymphadeneetomy was guided by the black-stained lymph nodes. 21 cases undergoing standard D2 lymphadenectomy served as controls （group 2）. The number of lymph nodes removed and the condition of lymphatic metastasis in two groups, black- stained lymph nodes in group 1, and postoperative complications were compared. Results The average lymph nodes dissected in group 1 （35. 1±13.4） were higher than in control group （26.2±7.8）. The differences were statistically significant （t = 2. 126, P = 0. 034 ）. The number of removed N2 and N3 lymph nodes in group 1 were more than that in control group. The total black-stained ration of lymph nodes was 52. 7% in group 1. The positive rate of lymph nodes was higher in black-stained lymph nodes （27.6%） than in unstained lymph nodes （ 10. 8% ） in group 1 and in control group （ 16.9% ）. The differences were also statistically significant （X^2 =6. 034, P =0. 016;X^2 =5. 142, P =0. 023）. Postoperative afferent loop obstruction developed in one case in group 1. Conclusions Lymphatic mapping guided D2 radical gastrectomy plus lymphadenectomy increases the number of lymph nodes dessected and improves the efficiency of positive lymph nodes excision for patients of advanced gastric cancer.