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目的探讨亚甲蓝示踪法前哨淋巴结(SLN)活检术在早期胃癌外科诊疗中的临床意义。方法 39例早期胃癌患者,术中用亚甲蓝示踪SLN,对SLN及所有术后胃周淋巴结进行HE染色,对SLN进一步行细胞角蛋白20(CK20)的免疫组化染色(IHC)及逆转录聚合酶链反应(RT-PCR)检测。比较3种检测方法对SLN转移灶检出的差异。结果 39例患者中,亚甲蓝示踪成功检出37例,检出成功率达94.5%。IHC与RT-PCR微转移检出率均为18.9%。由SLN状态预测胃周淋巴结转移情况:HE切片病检组前哨淋巴结检测准确率97.3%(36/37),假阴性率为16.7%(1/6);CK-20行IHC及RT-PCR组检测准确率97.3%(36/37),假阴性率为14.3%(1/7)。结论亚甲蓝示踪法能有效检出早期胃癌SLN。HE染色结合IHC及RT-PCR检测能提高SLN中微转移的检出率。
Objective To investigate the clinical significance of SLN biopsy in the surgical diagnosis and treatment of early gastric cancer. Methods 39 patients with early stage gastric cancer were treated with SLN with methylene blue during operation, HE staining of SLN and all postoperative gastric lymph nodes, immunohistochemical staining (IHC) of further cytokeratin 20 (CK20) in SLN and Reverse transcription polymerase chain reaction (RT-PCR) detection. The differences of SLN metastases between the three methods were compared. Results Of the 39 patients, 37 cases were successfully detected by methylene blue tracing, and the detection rate was 94.5%. IHC and RT-PCR micrometastasis detection rates were 18.9%. The gastric lymph node metastasis was predicted by the SLN status: the detection rate of sentinel lymph node in HE slice was 97.3% (36/37), the false negative rate was 16.7% (1/6); the IHC and RT-PCR of CK-20 The detection accuracy was 97.3% (36/37) and the false negative rate was 14.3% (1/7). Conclusion methylene blue tracer method can effectively detect early gastric cancer SLN. HE staining combined with IHC and RT-PCR detection can improve the detection rate of micrometastasis in SLN.