胃癌前哨淋巴结定位及活检技术

Lymphatic Mapping and Sentinel Lymph Node Biopsy in the Patients with Gastric Cancer

[目的]确定胃癌前哨淋巴结定位及活检技术的可行性及其预测各期胃癌淋巴结转移情况的准确性。[方法]使用专利蓝染料 ,对45例胃癌病人进行术中及术后前哨淋巴结定位和活检。[结果]在44例(97.78 %)中找到前哨淋巴结。有15例前哨淋巴结存在转移 ,其中10例非前哨淋巴结亦存在转移 ,5例前哨淋巴结为胃周淋巴结的唯一转移部位。有29例前哨淋巴结无转移 ,其中4例非前哨淋巴结存在转移。由前哨淋巴结状态预测胃周淋巴结转移情况的敏感性为78.95 % ,特异性为100 % ,准确率为90.91%。随着肿瘤增大 ,浸润程度加深 ,其特异性不变 ,但准确率下降。[结论]胃癌前哨淋巴结定位及活检技术是可行的 ,对于早期胃癌 ,前哨淋巴结的组织学状态可以准确反映胃周其余淋巴结的状况。将来治疗淋巴结转移阴性的胃癌中 ,这一技术有可能免除常规的淋巴结清扫。

To identify the feasibility of lymphatic mapping and sentinel lymph node(SLN) biopsy and examine its accuracy in predicting the status of regional lymphatic drainage basin for different stage disease in patients with gastric cancer.Forty_five patients with gastric cancer intraoperatively and postoperatively underwent lymphatic mapping and sentinel node biopsy with Patent Blue.The SLNs were found in 44(97.78%) of 45 patients, 19 patients were found to have lymph node metastases in SLNs or non SLNs, or both; 10 in both SLNs and non SLNs; 5 in SLNs alone; and 4 in non SLNs alone. SLNs status could diagnose the lymph node status of the patient with accuracy of 90.91%.The sensitivity was 78.95% and specificity was 100%. In T1 group, the diagnostic accuracy was 100%(sensitivity 100%, specificity 100%). In T2 group, the accuracy was 95.24%(sensitivity 87.5%, specificity 100%). In T3 group, the accuracy was 72.73%(sensitivity 57.14%, specificity 100%).[Conclusion]This study confirmed that the procedure of lymphatic mapping and sentinel node biopsy in the patients with gastric cancer is feasible. To early gastric cancer, the histologic characteristics of the SLN accurately predict the status of the patient .We believe that this technique may replace the lymph node dissection for gastric cancer patients without lymphatic metastasis.