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内镜-腹腔镜区域胃切除术联合前哨淋巴结清扫在早期胃癌患者中的应用研究

[Application research of endoscopic-laparoscopic regional gastric resection combined with sentinel lymph node basin dissection in patients with early gastric cancer].

作者信息

Zheng Z, Wang Z M, Xu R, Zhang H Q, Zhang Z, Ruan G T, Yin J, Liu X Y, Cai J, Chen G Y, Sun X J, Zhu S T, Li P, Zhang J, Zhang S T

机构信息

Department of General Surgery,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China.

National Clinical Research Center for Digestive Diseases,National Key Laboratory of Digestive Health,Beijing 100050,China.

出版信息

Zhonghua Wai Ke Za Zhi. 2025 Jul 1;63(7):587-596. doi: 10.3760/cma.j.cn112139-20250117-00034.


DOI:10.3760/cma.j.cn112139-20250117-00034
PMID:40443334
Abstract

To evaluate the short-term efficacy of endoscopic-laparoscopic regional gastric resection combined with sentinel lymph node basin dissection in patients with early-stage gastric cancer. This is a retrospective case series study. Data of 17 consecutive early gastric cancer patients from a prospective cohort at Beijing Friendship Hospital,Capital Medical University were analyzed between August 2023 and August 2024. Sixteen cases were from the department of general surgery and 1 from the department of gastroenterology. The cohort included 9 males and 8 females,with a mean age of 61.4 years (range: 46 to 79 years). Clinical data,including demographics,pathological features,surgical procedures,and follow-up outcomes,were collected through medical records and databases. All patients were followed for over 3 months,with follow-up ending on December 5,2024. A total of 17 patients were involved. Among them, 5 patients underwent endoscopic submucosal dissection (ESD) combined with laparoscopic sentinel lymph node dissection (LSBD),and another 3 patients who underwent complete ESD resection received LSBD due to pathological stage meeting the expanded indications. 6 patients who underwent non-curative ESD resection received laparoscopic gastric regional resection (LRG) combined with LSBD,and another 3 patients directly received LRG combined with LSBD. The average number of sentinel lymph nodes dissected before surgery ((IQR)) was 8.9 (4.5) (range: 4 to 21),and the detection rate and accuracy rate were both 100%. Postoperative pathology confirmed that there was no metastasis in the sentinel lymph nodes of 5 patients who underwent ESD combined with LSBD and 3 patients who underwent LSBD after complete ESD resection. The vertical and horizontal margins of ESD were all negative. One patient was an absolute indication for ESD. For the 6 patients who underwent non-curative ESD resection combined with LRG and LSBD,the horizontal margins were all negative. Two patients showed 1 metastasis in each of the 21 and 9 sentinel lymph nodes during the operation,and additional distal gastrectomy was performed during the operation. Postoperatively,73 and 39 lymph nodes were retrieved respectively. The former had 1 additional metastasis,while the latter had no metastasis. Among the 3 patients who underwent direct LRG combined with LSBD,the horizontal margins were negative. One patient was confirmed as an absolute indication for ESD by postoperative pathology,and one patient had 1 metastasis in 8 sentinel lymph nodes during the operation,and additional distal gastrectomy was performed. Postoperatively,there was no metastasis in 54 lymph nodes. All patients had no complications such as infection,bleeding,perforation,or death after surgery. Among the 14 patients who did not receive additional radical surgery,they were able to pass gas and defecate within 3 days after surgery,with an average hospital stay of 6 days. The nutritional indicators and gastric radionuclide emptying imaging half-emptying time were similar to those before surgery at 3 months after surgery. Laparoscopic and endoscopic cooperative regional gastrectomy with sentinel lymph node basin dissection has the advantages of minimal invasiveness,preservation of gastric function,and precise treatment. It maybe suitable for patients with early-stage gastric cancer at high risk of lymph node metastasis and has good short-term efficacy.

摘要

评估内镜-腹腔镜区域胃切除术联合前哨淋巴结清扫术治疗早期胃癌患者的短期疗效。这是一项回顾性病例系列研究。对2023年8月至2024年8月期间首都医科大学附属北京友谊医院前瞻性队列中的17例连续早期胃癌患者的数据进行了分析。16例来自普通外科,1例来自消化内科。该队列包括9名男性和8名女性,平均年龄61.4岁(范围:46至79岁)。通过病历和数据库收集临床数据,包括人口统计学、病理特征、手术方式和随访结果。所有患者均随访超过3个月,随访截至2024年12月5日。共纳入17例患者。其中,5例患者接受了内镜黏膜下剥离术(ESD)联合腹腔镜前哨淋巴结清扫术(LSBD),另外3例接受了完整ESD切除的患者因病理分期符合扩大适应证而接受了LSBD。6例接受非根治性ESD切除的患者接受了腹腔镜胃区域切除术(LRG)联合LSBD,另外3例患者直接接受了LRG联合LSBD。术前平均切除的前哨淋巴结数量(四分位间距)为8.9(4.5)(范围:4至21),检出率和准确率均为100%。术后病理证实,5例接受ESD联合LSBD的患者和3例ESD完整切除后接受LSBD的患者前哨淋巴结均无转移。ESD的垂直和水平切缘均为阴性。1例患者为ESD的绝对适应证。对于6例接受非根治性ESD切除联合LRG和LSBD的患者,水平切缘均为阴性。2例患者术中分别在21枚和9枚前哨淋巴结中发现1枚转移,术中追加了远端胃切除术。术后分别取出73枚和39枚淋巴结。前者有1枚额外转移,后者无转移。在3例直接接受LRG联合LSBD的患者中,水平切缘为阴性。1例患者术后病理证实为ESD的绝对适应证,1例患者术中在8枚前哨淋巴结中发现1枚转移,术中追加了远端胃切除术。术后54枚淋巴结无转移。所有患者术后均无感染、出血、穿孔等并发症或死亡。在14例未接受额外根治性手术的患者中,术后3天内即可排气排便,平均住院天数为6天。术后3个月营养指标和胃放射性核素排空显像半排空时间与术前相似。腹腔镜与内镜协作区域胃切除术联合前哨淋巴结清扫术具有微创、保留胃功能和精准治疗的优点。它可能适用于有淋巴结转移高风险的早期胃癌患者,且短期疗效良好。

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