CAJ | 학술논문

目的探讨早期胃癌(EGC)在前哨淋巴结(SLN)导航下行缩小手术的可行性和临床意义.方法将确诊的39例EGC患者随机分为SLN导航组(20例)和常规手术组(19例).导航组联用专利蓝和99m>Tc标记的硫胶体进行SLN活检,对17例SLN术中冰冻病理阴性的EGC行缩小的D0-D1病灶局部切除或胃部分切除术,余3例因SLN阳性行常规D2根治术.传统手术组19例均行D2根治术.计算SLN诊断EGC淋巴结转移情况的准确率和假阴性率,比较两组的手术情况、术后康复和1、3年无瘤生存率.结果 SLN检测成功率为100%(20/20),平均检出SLN 2.2个/例,由SLN诊断胃癌区域淋巴结转移状况的准确性为95%(19/20),假阴性率为5%(1/20).与22例传统手术相比,17例缩小手术在不降低术后无瘤生存率的前提下,显著缩短了手术时间,减少了术中出血量,加快了术后康复的速度,减少了手术并发症.结论 SLN活检可准确判断EGC的区域淋巴结转移情况,对SLN转移阴性的EGC病例行缩小的限制性手术既可保证根治效果又能获得微创益处.
목적 탐토조기위암(EGC)재전초림파결(SLN)도항하행축소수술적가행성화림상의의.방법 장학진적39례EGC환자수궤분위SLN도항조(20례)화상규수술조(19례).도항조련용전리람화99m>Tc표기적류효체진행SLN활검,대17례SLN술중빙동병리음성적EGC행축소적D0-D1병조국부절제혹위부분절제술,여3례인SLN양성행상규D2근치술.전통수술조19례균행D2근치술.계산SLN진단EGC림파결전이정황적준학솔화가음성솔,비교량조적수술정황、술후강복화1、3년무류생존솔.결과 SLN검측성공솔위100%(20/20),평균검출SLN 2.2개/례,유SLN진단위암구역림파결전이상황적준학성위95%(19/20),가음성솔위5%(1/20).여22례전통수술상비,17례축소수술재불강저술후무류생존솔적전제하,현저축단료수술시간,감소료술중출혈량,가쾌료술후강복적속도,감소료수술병발증.결론 SLN활검가준학판단EGC적구역림파결전이정황,대SLN전이음성적EGC병례행축소적한제성수술기가보증근치효과우능획득미창익처.
Objective To investigate the feasibility and clinical significance of sentinel lymph node(SLN) navigation limited surgery in early gastric cancer(EGC). Methods Thirty-nine patients confirmed with EGC between January 2002 and December 2006 were randomly divided into tailored surgery group (20 cases) and conventional surgery group ( 19 cases). By combining the mapping agents of 99m>Tc labeled sulfur colloid solution and blue violet, SLN biopsy was conducted in tailored surgery group, in which a limited gastric resection with DO-D1 lymphadenectomy was performed in 17 cases with negative SLN examined by routine HE staining during operation; standard radical gastrectomy with lymphadenectomy (D2) was conducted in the other 3 cases with positive SLN and in all the cases of conventional surgery group. The diagnostic accuracy and false-negative rate of SLN status were calculated respectively. The operation outcome and postoperative complication and survival rate were compared between the two groups. Results SLNs were detected in all 20 patients with a successful detection rate of 100% in tailored surgery group. The number of detected SLNs ranged from 1 to 3, with a mean of 2.2 per case. The diagnostic accuracy and false-negative rate was 95% and 5%, respectively. The hospital stay and recovery time of gastrointestinal functions in patients undergoing limited surgery were significantly shorter than in conventional surgery group and with similar postoperative survival and less complications. Conclusions SLN biopsy may provide an accurate diagnostic procedure for detecting lymph node metastasis in EGC. Patients with node-negative EGC receiving limited surgery are likely to benefit from minimally invasive approach with the similar survival as standard radical surgery.