T_(1～3)期胃癌术中前哨淋巴结活检的意义

The clinical significance of sentinel lymph node biopsy in T_(1~3) gastric cancer

目的观测T1～3期胃癌术中前哨淋巴结(SLN)的检出率及准确率,探讨其临床意义。方法在98例T1～3期胃癌根治术中,使用亚甲蓝进行染色,切取SLN,随后进行D2或D3手术。观测各T分期胃癌前哨淋巴结活检(SLNB)的检出率及准确率。结果 98例胃癌标本术后病理诊断为T1、T2、T3期分别为16、46及36例。术中SLN成功显影90例,检出率为91.8%。全组39例有淋巴结癌转移,其中SLN与非前哨淋巴结(non-SLN)均有转移者18例,仅SLN有转移者12例,仅non-SLN有转移者9例。T1～2期的检出率为96.8%,准确率为98.3%;T3期检出率为83.3%,准确率仅为73.3%。结论 SLNB可以准确预测T1～2期胃癌淋巴结转移状态,SLN阴性,有望免除常规D2淋巴结清扫。在T3期胃癌,SLNB可以发现异常淋巴结流注,改变淋巴结清扫范围,起到术中淋巴结导航的作用。

Objective To investigate the successful detection rate and accurate rate of sentinel nodes(SLN) in T1~3 gastric cancer.Methods Intraoperative lymphatic mapping and SLN biopsy(SLNB) with methylene blue were performed in 98 patients with T1~3 gastic cancer,who received subsequent standard radical gastrectomy with lymphadenectomy(D2 or D3).The successful detection rate and accurate rate of SLN were assessed.Results According to pathological diagnosis,T1,T2 and T3 gastric cancer were revealed in 16,46 and 36 cases,respectively.Stained nodes were detected in 90 cases(success rate:91.8%).Thirty-nine cases were found with lymph node metastasis;among whom metastasis in both SLN and non-SLN,SLN alone or non-SLN alone were revealed in 18,12 and 9 cases,respectively.The successful detection rates were 96.8% in T1~2 group and 83.3% in T3 group,with accurate rates of 98.3% and 73.3%,respectively.Conclusion SLNB accurately predicts the lymph node metastatic status in T1~2 gastric cancer patients,routine lymph node dissection can avoid unnecessary D2 surgery in negative sentinel lymph node metastasis.In T3 group,SLNB can find abnormal lymph flow,providing intraoperative lymph node navigation.