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目的:探讨前哨淋巴结(SLN)检测在胃癌诊断中的应用价值。方法:61例胃癌患者,术前经胃镜于病灶周围黏膜下注射锝标记的锍胶体,术中于病灶周围浆膜下注射亚甲蓝,待淋巴结蓝染后,用γ探测仪检测SLN,分析SLN的检出率、敏感性、准确率和阴性判断价值等。结果:本组SLN检出率为96.7%(59/61),SLN预测胃周淋巴结转移的敏感性为85.7%(18/21),假阴性率为14.2%(3/21),阴性判断价值为92.7%(38/41),准确率为94.9%(56/59)。SLN预测胃周淋巴结转移的敏感性随浸润深度增加而下降,T1期的敏感性为100.0%(6/6),T2期敏感性为88.9%(8/9),T3期为66.7%(4/6);T1+T2期总体敏感性为93.3%(14/15),准确性为98.1%(51/52)。假阴性的3例均为原发肿瘤>4.0cm的低分化癌或黏液腺癌。结论:联合染料与核素法有较高的SLN检出率,可较为准确地预测T1、T2期胃癌周围淋巴结转移状态,并可指导淋巴结清除范围。对肿瘤>4.0cm的低分化癌及黏液腺癌要警惕假阴性可能。
Objective: To investigate the value of sentinel lymph node (SLN) detection in the diagnosis of gastric cancer. Methods: Sixty-one patients with gastric cancer underwent gastroscopic injection of technetium-labeled sulfonium colloid under the submucosa of the lesion. Intraoperatively, methylene blue was injected subserosa into the lesion. After lymph node staining, SLN was detected by gamma detector. SLN detection rate, sensitivity, accuracy and negative judgment value. Results: The detection rate of SLN in this group was 96.7% (59/61). The sensitivity of SLN in predicting gastric lymph node metastasis was 85.7% (18/21) and false negative rate was 14.2% (3/21). The negative predictive value Was 92.7% (38/41), the accuracy was 94.9% (56/59). The sensitivity of SLN predicting the metastasis of gastric lymph node decreased with the increase of invasion depth. The sensitivity of SLN was 100.0% (6/6) in T1, 88.9% (8/9) in T2 and 66.7% in T3 / 6). The overall sensitivity was 93.3% (14/15) in T1 + T2 and the accuracy was 98.1% (51/52). False negative in 3 cases were primary tumors> 4.0cm of poorly differentiated carcinoma or mucinous adenocarcinoma. CONCLUSION: The combined dye and nuclide method has a high detection rate of SLN, which can predict the metastatic status of lymph nodes around T1 and T2 gastric cancer more accurately and guide the lymph node clearance. On the tumor> 4.0cm of poorly differentiated carcinoma and mucinous adenocarcinoma to be alert to false negative possible.