Mitsumori Norio, Nimura Hiroshi, Takahashi Naoto, Kawamura Masahiko, Aoki Hiroaki, Shida Atsuo, Omura Nobuo, Yanaga Katsuhiko
Norio Mitsumori, Hiroshi Nimura, Naoto Takahashi, Masahiko Kawamura, Hiroaki Aoki, Atsuo Shida, Nobuo Omura, Katsuhiko Yanaga, Department of surgery, the Jikei University School of Medicine, Nisi-shinbashi, Minato-ku, Tokyo 105-8461, Japan.
World J Gastroenterol. 2014 May 21;20(19):5685-93. doi: 10.3748/wjg.v20.i19.5685.
We attempted to evaluate the history of sentinel node navigation surgery (SNNS), technical aspects, tracers, and clinical applications of SNNS using Infrared Ray Electronic Endoscopes (IREE) combined with Indocyanine Green (ICG). The sentinel lymph node (SLN) is defined as a first lymph node (LN) which receives cancer cells from a primary tumor. Reports on clinical application of SNNS for gastric cancers started to appear since early 2000s. Two prospective multicenter trials of SNNS for gastric cancer have also been accomplished in Japan. Kitagawa et al reported that the endoscopic dual (dye and radioisotope) tracer method for SN biopsy was confirmed acceptable and effective when applied to the early-stage gastric cancer (EGC). We have previously reported the usefulness of SNNS in gastrointestinal cancer using ICG as a tracer, combined with IREE (Olympus Optical, Tokyo, Japan) to detect SLN. LN metastasis rate of EGC is low. Hence, clinical application of SNNS for EGC might lead us to avoid unnecessary LN dissection, which could preserve the patient's quality of life after operation. The most ideal method of SNNS should allow secure and accurate detection of SLN, and real time observation of lymphatic flow during operation.
我们试图评估前哨淋巴结导航手术（SNNS）的历史、技术层面、示踪剂以及使用红外线电子内窥镜（IREE）联合吲哚菁绿（ICG）的SNNS的临床应用。前哨淋巴结（SLN）被定义为首个接收来自原发肿瘤癌细胞的淋巴结（LN）。自21世纪初以来，关于SNNS在胃癌临床应用的报道开始出现。日本也完成了两项关于胃癌SNNS的前瞻性多中心试验。北川等人报告称，用于前哨淋巴结活检的内镜双重（染料和放射性同位素）示踪剂方法应用于早期胃癌（EGC）时被证实是可接受且有效的。我们之前报道了使用ICG作为示踪剂，联合IREE（日本东京奥林巴斯光学公司）检测SLN在胃肠道癌中的有效性。早期胃癌的淋巴结转移率较低。因此，SNNS在早期胃癌中的临床应用可能会使我们避免不必要的淋巴结清扫，从而在术后保留患者的生活质量。最理想的SNNS方法应能安全、准确地检测前哨淋巴结，并在手术过程中实时观察淋巴引流情况。
