术中亚甲基蓝标定清扫淋巴结提高贲门癌患者生存率

Intraoperative lymph node dissection of methylene blue calibration improves cardiac cancer survival rate

目的分析术中直视下亚甲基蓝标定贲门周围淋巴结,引导清扫根治,观察对术后3年无病生存率、5年总生存率的影响。方法选择年龄小于70岁,贲门癌单瘤体直径小于8cm,Ⅰ期至ⅢB期患者,随机分为2组。A组常规行D2根治术。B组术中在瘤体周围注入亚甲基蓝,显示周围淋巴结,引导清扫切除,术后随访5年。结果 A组术后3年无病生存率和5年总生存率分别为59%和37%,B组为74%和53%。结论术中直视下行瘤体周围淋巴结标定能较完整地切除前哨淋巴结及被染色而肉眼不易发现的<2mm阳性微小淋巴结,提高了术后3年无病生存率和5年总生存率。该技术简单可行、实用性强,临床可以推广应用。

Objective To analyze the effect of open surgery of methylene blue calibration around the lower esopha- geal segment cardia lymph on postoperative 3-year disease-free survival rate and 5-year overall survival rate. Meth- ods Patients less than 70-year-old, the cardia single tumor less than 8era, stage Ⅰ to Ⅲ B were randomly divided into 2 groups. Group A： D2 radical mastectomy. Group B： injected into the methylene blue around the cardia tumor and surrounding lymph nodes, so as to guide cleaning resection. Patients were followed up for 5 years. Re- suits A postoperative 3-year disease-free survival and overall 5-year survival rates were 59% and 37%. Group B 74% and 53% respectively. Conclusions Intraoperative lymph nodes around the tumor look straight down the cali- bration can be more complete excision and sentinel lymph node was stained and visually difficult to find 〈 2 mm ti- ny positive lymph nodes, increased after 3-year disease-free survival and overall 5-year survival rate. The technique is simple and feasible, practical, clinical applications could be extended.