Jiang Huai-wu, Jian Xun, Xiao Shi-ming, Chen Jin, Tao Ya
Department of Surgery, The Second Affiliated Hospital of North Sichuan Medical College, Mianyang 621000, China.
Zhonghua Yi Xue Za Zhi. 2007 Jan 23;87(4):268-70.
To develop a new method of lymph node tracing in gastrectomy for advanced gastric carcinoma (AGC).
Forty-six patients with gastric angle carcinoma with metastasis in the third group lymph nodes underwent radical operation. During the operation methylene blue was injected inside or around the border of the metastatic third group lymph nodes. The secondary sentinel lymph nodes (SSLNs) that were the nearest to the third group lymph nodes were searched in 5 approximately 10 minutes, and the SSLNs discovered were resected to undergo HE staining and immunohistochemistry.
SSLNs were found in 38 patients with a positive rate of 82.6% by methylene blue staining. Pathological examination found SSLNs in 30 cases with a positive rate of 78.9%. Totally 68 SSLNs were found in the 38 patients. The numbers of methylene blue positive SSLN in the groups 7, 5, 4, 6, 9, and 8 were 40, 9, 7, 5, 4, and 3 respectively. Pathology and histochemistry found 31, 9, 5, 4, 2, and 1 SSLNs in the groups 7, 5, 4, 6, 9, and 8 with the positive rates of 77.5%, 100%, 71.4%, 80.0%, 50.0%, and 33.3% respectively. There were no significant correlation between the size and degree of differentiation of tumor and the positive rate of SSLN.
The technique of SSLN tracing expands the application range of SLN tracing and provides a new thinking for study of lymph node in gastric carcinoma in different stages.
探索一种进展期胃癌（AGC）胃切除术中淋巴结示踪的新方法。
46例胃角癌伴第三组淋巴结转移患者接受根治性手术。术中在转移的第三组淋巴结内部或边界周围注射亚甲蓝。约5分钟后每隔10分钟在距离第三组淋巴结最近处寻找第二级前哨淋巴结（SSLNs），将发现的SSLNs切除并进行苏木精-伊红（HE）染色和免疫组化检查。
38例患者通过亚甲蓝染色发现了SSLNs，阳性率为82.6%。病理检查发现30例存在SSLNs，阳性率为78.9%。38例患者共发现68个SSLNs。第7、5、4、6、9和8组中亚甲蓝阳性的SSLNs数量分别为40、9、7、5、4和3个。病理和组织化学检查发现第7、5、4、6、9和8组分别有31、9、5、4、2和1个SSLNs，阳性率分别为77.5%、100%、71.4%、80.0%、50.0%和33.3%。肿瘤大小和分化程度与SSLN阳性率之间无显著相关性。
SSLN示踪技术扩大了前哨淋巴结示踪的应用范围，为不同阶段胃癌淋巴结的研究提供了新思路。
