内镜黏膜下剥离术联合腹腔镜前哨淋巴结活检术治疗早期胃癌26例分析

Endoscopic Submucosal Dissection Combined Laparoscopic Sentinel Lymph Node Biopsy for Early Gastric Cancer:A Report of 26 Cases

目的 探讨内镜黏膜下剥离术（ESD）联合腹腔镜前哨淋巴结活检术治疗早期胃癌的可行性和临床疗效。方法 回顾性分析2009年3月至2013年8月期间在江南大学附属医院行ESD联合腹腔镜前哨淋巴结活检术治疗的26例早期胃癌患者的临床资料。对这些患者先行腹腔镜前哨淋巴结活检术，如冰冻病理学检查结果提示有淋巴结转移，则行腹腔镜下胃癌D2根治术；如提示无淋巴结转移，则行ESD。结果 本组26例患者共检出SLN 95枚，（3.7±1.4）枚/例，（1～6枚/例）；有2例患者因SLN阳性而行腹腔镜辅助远端胃癌根治术，24例患者行ESD。26例患者术后随访时间5～46个月，中位随访时间22个月。ESD术后无病生存率（DFS）为91.7% （22/24），局部复发率为4.2% （1/24）；总体DFS为96.2% （25/26）。结论 ESD治疗早期胃癌是安全、可行的，联合腹腔镜胃癌前哨淋巴结活检术更符合肿瘤根治原则。

Objective To explore the feasibility and clinical efficacy of laparoscopic sentinel lymph node biopsy combined with endoscopic submucosal dissection （ESD） for patients with early gastric cancer （EGC）. Methods The clinical data of 26 cases who received ESD combined with laparoscopic sentinel lymph node biopsy for EGC between March 2009 to August 2013 in Affiliated Hospital of Jiangnan University were analyzed retrospectively. These patients first underwent laparoscopic sentinel lymph node （SLN） biopsy. If frozen sectioning examination suggested there was lymph node metastasis， laparoscopic D2 radical gastrectomy would be operated. However， the ESD would be operated if the frozen sectioning examination was negative. Results The total numbers of SLN were 95， and mean numbers of SLN were 3.7±1.4 （range from 1 to 6）. Two patients with positive SLN underwent laparoscopic-assisted distal gastrectomy and 24 patients with negative SLN underwent ESD. The disease free survival （DFS） and local recurrence rate after ESD for EGC was 91.7% （22/24） and 4.2% （1/24）， respectively. And the total DFS for all patients was 96.2%（25/26）. Conclusion ESD for EGC is a safe and feasible procedure， combined with laparoscopic sentinel lymph node biopsy conforms more to the concept of principle of radical operation.