Ichikura Takashi
Department of Surgery, National Defense Medical College, Tokorozawa, Japan.
Nihon Geka Gakkai Zasshi. 2009 Mar;110(2):68-72.
Sentinel lymph nodes (SLNs) are identified by injecting lymphatic tracer dye or radioisotope-labeled particles, or both, around a gastric tumor into the submucosa endoscopically or into the subserosa from the exterior of the stomach. Many reports have suggested the feasibility of the SLN concept in T1 gastric cancer. We consider it reasonable to convert from D1+alpha/beta dissection to D2 dissection when an SLN biopsy is positive and have used this strategy since 2000. Although false-negative SLN biopsy results cannot be avoided, previous studies suggested that the dissection of lymph node stations where SLNs occur (SLN stations) may minimize the possibility of leaving metastases, even micrometastases, behind in cases of a negative SLN biopsy. Since 2003, we have performed limited gastrectomy with dissection of SLN stations when the SLN biopsy was negative. A sleeve gastrectomy was sometimes needed due to the distribution of SLN stations or the location of the tumor. It is preferable to conclude the surgery with endoscopic submucosal dissection in cases of negative SLN biopsy, which is performed laparoscopically. For this final goal, it is mandatory to standardize the method of SLN identification and to increase the sensitivity of intraoperative diagnosis of lymph node metastases.
前哨淋巴结（SLN）可通过在内镜下将淋巴示踪染料或放射性同位素标记颗粒或两者同时注入胃肿瘤周围的黏膜下层，或从胃外部注入浆膜下层来识别。许多报告表明SLN概念在T1期胃癌中具有可行性。我们认为，当SLN活检呈阳性时，从D1+α/β清扫转换为D2清扫是合理的，并且自2000年以来一直采用这种策略。尽管无法避免SLN活检出现假阴性结果，但先前的研究表明，对出现SLN的淋巴结站（SLN站）进行清扫，即使在SLN活检为阴性的情况下，也可能将遗留转移灶（甚至微转移灶）的可能性降至最低。自2003年以来，当SLN活检为阴性时，我们进行了有限胃切除术并清扫SLN站。由于SLN站的分布或肿瘤的位置，有时需要进行袖状胃切除术。在SLN活检为阴性的情况下，最好通过腹腔镜进行的内镜黏膜下剥离术来完成手术。为了实现这一最终目标，必须规范SLN识别方法并提高术中淋巴结转移诊断的敏感性。
