胃癌前哨淋巴结检测的临床研究

Clinical Research on the Sentinel Lymph Node Biopsy in Gastric Cancer

目的:探讨胃癌术中前哨淋巴结(sentinel lymph node,SLN)定位检测的可行性及其临床意义。方法:使用亚甲蓝对40例胃癌患者行前哨淋巴结术中标识活检,随后行D2或D2以上手术。结果:40例胃癌患者中,38例找到前哨淋巴结,检出率为38/40(95%),有32例存在SLN转移,8例SLN为唯一转移部位,且均为T1、T2期。由SLN的病理学状态来预测胃周围淋巴结转移情况的敏感性为32/34(94.12%),特异性为4/4(100%),假阴性率为2/34(5.88%),准确率为34/38(89.47%),其中假阴性的2例,肿瘤都处于T4期。结论:胃癌SLN定位及活检技术能较准确反映早期胃癌的淋巴结转移状况,但对进展期胃癌而言假阴性率较高,对胃癌整个区域淋巴结状态预测的可靠性和可行性尚需进一步验证。

Objective： To identify the feasibility and clinical significance of sentinel lymph node （SLN） in gastric cancer. Methods： Methylene blue was used to map lymphatic and SLNB forty patients with gastric cancer intraoperatively, then they were underwent D2 or 〉D2 surgery. Results： Among 40 cases included, the SLN was identified successfully in 38 cases. The detection rate was 95%（38/40）. 32 patients were found to have lymph node metastasis in SLNs, 8 in SLNs alone all in T1 and T2 group, The sensitivity of SLN status in the diagnosis of the lymph node metastasis status of the patients was 94.12%, false nagetive rate was 5.88%, Specificity was 100% and accuracy was 89.47%, 2 patients were found to have false nagetive lymph node metastasis in SLN, all in T4 group. Conclusion： The study confirmed that the procedure of lymphatic mapping and sentinel lymph node biopsy in the patients with gastric cancer was feasible. For the early gastic cancer, the histologic of the SLN accurately predict the status of the patients. For high false negative rate of SLN detection in advanced gastric cancer. Further verifying the reliability and feasibility of SLN was required on the area of gastric cancer lymph node status prediction.