联合使用蓝染料和Tc同位素测定胃癌前哨淋巴结的临床意义

目的探讨胃癌中前哨淋巴结（sentinel lymphnode，SLN）概念的适用性，评估前哨淋巴结活检预测胃癌区域淋巴结转移状态的价值及其指导胃癌淋巴结清扫范围的临床意义。方法46例胃癌患者，术前经胃镜于病灶周围黏膜下注入锝标记的锡胶体，术中于病灶周同浆膜下分点注入亚甲蓝，待亚甲蓝显示淋巴结后，将γ探测仪检测到的放射活性最高的淋巴结视为胃癌前哨淋巴结，行术中冰冻免疫组化和常规病理检查或进一步行常规免疫组化染色，分别计算前哨淋巴结诊断胃癌淋巴结转移状态的准确性、敏感性、阴性预测值。结果胃癌前哨淋巴结的检出成功率为100％（46／46）。联合法测定SLN诊断胃癌周围淋巴结转移状态的准确性为100％．敏感性为100％，阴性预测值为100％。结论前哨淋巴结概念适合于胃癌；联合使用蓝染料和锝标锡胶体示踪检测胃癌前哨淋巴结可准确预测胃癌周围淋巴结的转移状态，并可能用于指导胃癌的淋巴结清扫范围。

Sentinel lymph node detection combining with the methylene blue and 99mTc-tincolloid injection in gastric cancer

Objective To investigate the detection of feasibility and accuracy of sentinel lymph nodes （SLN）with combining the methylene blue and 99mTc-tincolloid injection in gastric cancer and assess its potential role in determining the rational extent of lymphadenectomy in gastric cancer surgery. Methods 46 patients of gastric cancer were enrolled in this study. Endoscopic injection submucosally of was performed around the primary tumor 17-18h before operation.Immediately after laparotomy,metbylene blue was injected into subserosal layer adjacent to the tumor.After the methylene blue showing the lymph nodes mapping, SLNs were defined as the most radioactivity than surrounding tissue with γprobe.Standard radical gastrectomy with lymphadenectomy （D3）was performed.All resected nodes were examined postoperatively by routine HE and rapid frozen cytokeratin immunohistochemistical stain and those negative SLNs were examined with further eytokeratin immunohistochemistical staining.The diagnostic accuracy,sensitivity,and negative predictive value of regional lymph node status on the basis of SLN status were calculated respectively. Results SLNs were detected in 46 of 46 patients with a successful detection rate of 100%. The diagnostic accuracy,sensitivity,and negative predictive value were 100%, 100%,and 100% respectively. Conclusion The SLN concept is validated in gastric cancer.Combined-agent SLN mapping is an accurate diagnostic procedure for detecting lymph node metastasis in patients with gastric cancer and may indicate rational extent of lymphadenectomy for gastric cancer.