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目的探讨内镜黏膜下剥离术(ESD)联合腹腔镜前哨淋巴结活检术治疗早期胃癌的可行性和临床疗效。方法回顾性分析2009年3月至2013年8月期间在江南大学附属医院行ESD联合腹腔镜前哨淋巴结活检术治疗的26例早期胃癌患者的临床资料。对这些患者先行腹腔镜前哨淋巴结活检术,如冰冻病理学检查结果提示有淋巴结转移,则行腹腔镜下胃癌D2根治术;如提示无淋巴结转移,则行ESD。结果本组26例患者共检出SLN 95枚,(3.7±1.4)枚/例,(1~6枚/例);有2例患者因SLN阳性而行腹腔镜辅助远端胃癌根治术,24例患者行ESD。26例患者术后随访时间5~46个月,中位随访时间22个月。ESD术后无病生存率(DFS)为91.7%(22/24),局部复发率为4.2%(1/24);总体DFS为96.2%(25/26)。结论 ESD治疗早期胃癌是安全、可行的,联合腹腔镜胃癌前哨淋巴结活检术更符合肿瘤根治原则。
Objective To investigate the feasibility and clinical efficacy of endoscopic submucosal dissection (ESD) and laparoscopic sentinel lymph node biopsy in the treatment of early gastric cancer. Methods The clinical data of 26 patients with early gastric cancer treated by ESD combined with laparoscopic sentinel lymph node biopsy in the Affiliated Hospital of Jiangnan University from March 2009 to August 2013 were retrospectively analyzed. Laparoscopic sentinel lymph node biopsy is performed on these patients. If the frozen pathological examination indicates lymph node metastasis, then D2 laparoscopic radical gastrectomy is performed. If no lymph node metastasis is indicated, ESD is performed. Results A total of 95 SLNs (3.7 ± 1.4) / cases (1-6 cases / case) were detected in 26 patients in this study. Laparoscopy assisted radical gastrectomy was performed in 2 patients due to SLN. 24 Patients with ESD. Twenty-six patients were followed up for 5-46 months with a median follow-up of 22 months. The rate of disease-free survival (DFS) after ESD was 91.7% (22/24) and the local recurrence rate was 4.2% (1/24). The overall DFS was 96.2% (25/26). Conclusion ESD treatment of early gastric cancer is safe and feasible, combined with laparoscopic sentinel lymph node biopsy of gastric cancer more in line with the principle of radical tumor.