腹腔镜“淋巴引流区”清扫联合胃局部切除术治疗早期胃癌的再认识

Recognition of Laparoscopic Local Gastrectomy Combined with Lymphatic Basin Dissection on Early Gastric Cancer

前哨淋巴结的检查和活检对于及时诊断和治疗肿瘤非常重要。临床上针对早期胃癌常采用内镜黏膜下剥离术等技术,但存在无法精确直观地判断有无淋巴结转移导致错失治疗时机等风险。胃恶性肿瘤中存在包含着前哨淋巴结的"淋巴引流区",腹腔镜下对"淋巴引流区"进行清扫可以获取前哨淋巴结,并通过对清扫获得的前哨淋巴结进行活检来指导手术。由此"淋巴引流区"清扫联合胃局部切除术不仅能够达到内镜黏膜下剥离术的治疗效果,同时又能避免遗漏肿瘤淋巴结微转移的风险,是一种值得推荐的手术方式。本文针对此术式的相关难点及问题进行综述,以供临床借鉴参考。

Sentinel node （SN） detection and biopsy are important for timely diagnosis and treatment of cancer. Endoscopic submucosal dissection technique is clinically used to treat early gastric cancer, but there is not accurate intuitive judgment of lymph metastasis so as to increase the risk of missing the timing of treatment. Malignant gastric tumor contains lymphatic basin with the sentinel lymph node. Sentinel lymph node can be obtained to guide the surgery by lymphatic basin dissection. So, laparoscopic local gastrectomy combined with lymphatic basin dissection is a recommendable operation, and it can not only achieve the therapeutic effect of endoscopic submucosal dissection but also avoid the risk of lymph node micrometastasis. In this paper, the related difficulties and problems of this technology are summarized for clinical reference.