胃癌前哨淋巴结导航手术的研究

目的探讨胃癌前哨淋巴结（SLN）活检技术在治疗胃癌疾病中的价值．方法通过使用亚甲蓝对40例患有胃癌疾病的患者行前哨淋巴结术中标识活检，术后进行常规HE病理和免疫组化检查，用统计学方法对结果进行分析，探讨术中注射亚甲蓝后前哨淋巴结的表达情况．结果在40例中有39例检出SLN，其检出率为97．5％．一共检出54枚淋巴结，平均每例1．35枚．由SLN组织学状态预测胃癌区域淋巴结转移状况的准确率为92．6％（36／39），敏感性为87．5％（21／24），假阴性率为12．5％（3／24）．同时，SLN预测胃周淋巴结转移的敏感性和准确性随胃癌浸润的深度增加而降低，T1期的敏感性及准确性是100％，T3期的敏感性及准确性是84．6％、88．2％．21例转移的SLN中，3例为SLN唯一转移部位，均为T1、T2期．结论SLN能较准确地反映早期胃癌的淋巴结转移状况，为进一步行前瞻『生研究提供理论依据，也为早期胃癌患者制定合理的手术方案提供了依据．

On Sentinel Lymph Node Navigation Surgery for Gastric Cancer

Objective To investigate the clinical value of sentinel lymph nodes （SLN） biopsy in treating gastric cancer. Methods The identification biopsy of intraoperative SLN on 40 patients with gastric cancer was performed. During the operation, the sentinel nodes were oriented by injecting methylene blue. The sentinel lymph nodes were then removed for the pathological studies with HE staining and immunohistochemical method. The results were analyzed by using the statistical method to investigate the expression of intraoperative sentinel lymph node after the injection of methylene blue. Results There were 39 patients whose SLN were detected among of 40 patients and the detection rate was 97.5%. Totally,54 lymph nodes were detected, with an average of 1.35 per patient. The SLN histological prediction showed that the accuracy rate of the lymph node metastasis in the stomach cancer region was 92.6% （36/39） ,the sensitivity was 87.5% （21/24） and false negative rate was 12. 5% （3/24）. Moreover, the accuracy rate and sensitivity of the metastasis of lymph nodes around stomach through the SLN prediction decreased with the increase of the depth of gastric cancer invasion. The sensitivity and accuracy rate at T1 phase were 100% , T3 were 84.6% and 88.2% respectively. Among 21 cases of SLN metastasis,3 cases showed that SLN was the only metastatic site ,and it appeared in T1 and T2 stage. Conclusion Sentinel node biopsy could provide an accurate information for the node metastasis in early gastric carcinoma and theoretical evidences both for the further prospective research and drawing up a reasonable operation scheme for early gastric cancer.