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自从腹腔镜在胃癌治疗中应用以后,短期的治疗效果与传统开腹手术相比,患者术后在生活质量上有所提高。然而,腹腔镜胃癌手术对生存质量的长期的改善作用仍在争论中。这可能由于腹腔镜下胃癌手术与开放手术有着相同的胃切除及淋巴结清扫范围造成的。为了提高胃癌手术患者长期的生存质量而又不影响复发与生存,通过腹腔镜行胃功能保留手术及最小范围的淋巴清扫使肿瘤无残留的方式是应该被考虑的。为了达到这个目的,前哨淋巴结活检(SNB)的概念被提出来。在敏感性方面SNB的结果在不同的机构是有差异性和不令人满意的,然而最近来自日本的多中心研究给我们提供了乐观的结果。目前在韩国,前哨淋巴结导航方法研究小组对应用SNB保留胃功能手术的方法进行III期试验,在这之前,参与机构在标准化及克服SNB学习曲线的质量管理研究已经在进行中。如果SNB及保留胃功能的手术可以在III期试验中证实,那么这种方式因其不影响复发与生存可能取代早期胃癌患者的标准胃切除及淋巴结清扫术,成为早期胃癌的一种更好的外科治疗选择。
Since the application of laparoscopy in the treatment of gastric cancer, short-term treatment effect compared with the traditional open surgery, the patient’s quality of life improved after surgery. However, the long-term quality of life improvement of laparoscopic gastric surgery remains controversial. This may be due to laparoscopic gastric surgery and open surgery with the same gastrectomy and lymph node dissection caused. In order to improve the long-term quality of life of gastric cancer patients without affecting recurrence and survival, no residual tumor should be considered by laparoscopic gastric function-preserving surgery and minimal lymph node dissection. For this purpose, the concept of sentinel lymph node biopsy (SNB) has been proposed. The results of SNB in terms of sensitivity are both differentiated and unsatisfactory in different institutions, however recent multicenter studies from Japan have provided us with optimistic results. Currently in Korea, the Sentinel Lymph Node Navigation Study Group conducted Phase III trials of SNB-preserving gastric function surgeries. Prior to this, participating organizations were already in the process of standardizing and overcoming SNB learning curve quality management studies. If SNB and gastric-preserving surgery can be confirmed in phase III trials, this approach is a better early gastric cancer because of its standard gastrectomy and lymph node dissection, which may not replace relapse and survival in patients with early gastric cancer Surgical treatment options.