前哨淋巴结导航技术在老年早期胃窦部腺癌手术中的应用价值

Value of sentinel lymph node navigation in the operation of elderly patients with early gastric antral adenocarcinoma

目的探讨老年早期胃窦部腺癌患者手术中采用专利蓝示踪前哨淋巴结(SLN)预测胃周淋巴结转移状态的临床价值。方法选择2014年6月至2016年6月河南科技大学第一附属医院收治的老年早期胃窦部腺癌患者48例,所有患者行远端胃大部切除术,手术时,先将专利蓝液(1∶1稀释)注射于肿瘤周围浆膜下,找到最先染色的胃周SLN,然后行D2根治术,术后将SLN及其余各组淋巴结进行病理检查,评估胃周淋巴结转移状态。结果 48例患者中,46例患者通过术中专利蓝示踪检出SLN,检出率为95.8%(46/48)。应用专利蓝示踪SLN状态来预测老年早期胃窦部腺癌患者胃周淋巴结转移的准确性为91.3%(42/46),敏感性为80.0%(16/20),特异性为100.0%(26/26),假阴性率为11.1%(2/18)。SLN转移阳性率、检出率、准确性、敏感性及假阴性率与患者性别无显著相关性(P>0.05);SLN转移阳性率与肿瘤浸润深度有显著相关性(P<0.01),而SLN检出率、准确性、敏感性及假阴性率与肿瘤浸润深度无显著相关性(P>0.05)。结论老年早期胃癌患者手术时使用专利蓝进行SLN示踪可以较为准确地判断胃周淋巴结转移情况。

Objective To investigate the clinical value of patent blue tracing sentinel lymph node （SLN） in predicting the lymph node metastasis in elderly patients with early gastric antral adenocarcinoma. Methods Forty-eight patients with ear- ly early gastric antral adenocarcinoma who underwent distal subtotal gastrectomy in the First Affiliated Hospital of Henan Uni- versity of Science and Technology from June 2014 to June 2016 were selected. During the operation, the patent blue liquid （1 ： 1 dilution） was injected into the serous membrane around the tumor to find the stained gastric SLN, and then the D2 radi- cal operation was performed. The SLN and other lymph nodes were performed with pathological examination to evaluate the sta- tus of lymph node metastasis. Results In the 48 cases, SLN was detected by intraoperative patent blue tracer in 46 patients, the detection rate of SLN was 95.8% （46/48）. The accuracy, sensitivity, specificity and false negative rate of patent blue trac- ing SLN to predict the lymph node metastasis in elderly patients with early gastric adenocarcinoma was 91.3% （42/46） , 80. 0% （16/20） , 100.0% （26/26） and 11.1% （2/18） respectively. The SLN metastasis positive rate, detection rate, accura- cy, sensitivity and false negative rate were unrelated to the gender of the patients （ P 〉 0.05 ）. The SLN metastasis positive rate was significantly correlated with the tumor invasion （P 〈 0.01 ） ;but the detection rate, accuracy, sensitivity and false negative rate were unrelated to the tumor invasion（P 〉 0.05）. Conclusion Using patent blue to track SLN can accurately evaluate the status of perigastric lymph node metastasis in the operation of the elderly patients with early gastric antral adenocarcinoma.