【作者】 王辉；

【导师】 龙跃平；

【作者基本信息】 华中科技大学 ， 外科学， 2016， 硕士

【摘要】 目的:通过分析胃癌患者的临床病理资料,评估淋巴示踪剂卡纳琳对转移淋巴结的示踪效果,探讨影响胃癌淋巴结转移的相关因素及第8p组淋巴结清扫的价值。方法:我们收集了从2014年10月至2015年8月于华中科技大学同济医学院附属协和医院胃肠外科行手术治疗的50例胃癌患者的临床病理资料。35例术中应用淋巴示踪剂卡纳琳,术后淋巴结根据染色情况以阴性或阳性标记、分组,15例未用淋巴示踪剂作为对照组。根据清扫淋巴结数目、淋巴结染色及转移情况,分别计算灵敏度、特异度、假阳性率、假阴性率,评估淋巴示踪剂卡纳琳对转移淋巴结的示踪效果。50例均施行了D2根治术附加第8p组淋巴结清扫,通过总体淋巴结转移和第8p组淋巴结转移情况与胃癌临床病理特征的多因素分析,探索影响胃癌淋巴结转移的相关因素,探讨第8p组淋巴结清扫的价值。结果:示踪剂组平均检出淋巴结个数为45.7/例,明显多于未用示踪剂组平均检出淋巴结数目(39.2/例),但两者之间无统计学意义(P=0.138>0.05)。应用示踪剂组与未用示踪剂组的年龄、性别、BMI、肿瘤大小、肿瘤部位、手术类型、组织类型、T分期、N分期(P均>0.05)均未见显著差异。应用示踪剂组34例出现淋巴结黑染,成功率为97%,淋巴结黑染率为36%。灵敏度、特异度、假阴性率分别为:28%,62%及72%。50例中有36例出现淋巴结转移,21例转移局限于第1站。对于胃上部(U区)肿瘤No.1组、No.7组和No.3组淋巴结转移最常见,No.4d组、No.6组淋巴结则为胃下部(L区)肿瘤常见转移部位。淋巴结转移与T分期显著相关(P=0.004<0.05),有无淋巴结转移与患者的年龄(P=1)、性别(P=0.646)、BMI(P=0.412)、肿瘤大小(P=0.409)、肿瘤部位(P=0.754)、组织类型(P=0.797)、Bormann分型(P=0.156)均没有显著性差异。6例出现第8p组淋巴结转移,其TNM及临床分期分别为:T1N2M0ⅡA期,T3N3M0ⅢB期,T4aN3M0ⅢC期,T4aN3M0ⅢC期,T4aN3M0ⅢC期,T4bN3M0ⅢC期。第8p组淋巴结转移与N分期显著相关(P=0.007<0.05),与年龄、性别、BMI、肿瘤大小、肿瘤部位、组织类型、T分期、临床分期、Bormann分型(P均<0.05)均没有显著性差异。结论:作为淋巴示踪剂,卡纳琳并没有证明其对转移淋巴结具有良好的选择性。淋巴结转移主要与肿瘤浸润深度有关,由于样本量不足,淋巴结转移情况与肿瘤大小、肿瘤部位、组织类型、Bormann分型等均未见显著性差异,仍需进一步研究。第8p组淋巴结转移则与N分期显著相关,对于术前评估N2分期以上的病例建议行第8p组淋巴结清扫。更多还原

【Abstract】 ObjectiveWe sought to investigate the characterizes of lymph node metastasis in 50 patients gastric cancer were confirmed without any treatment preoperatively in order to acquire preliminary patterns of lymphatic drainage in gastric cancer, the evaluation of tracing effect of carbon nanoparticles and the related factors of lymph node metastasis and No.8p subgroup.MethodsWe reviewed the information of patients underwent gastrectomy for gastric cancer from October 2014 to August 2015, a total of 50 patients without any treatment and distant metastasis preoperatively were enrolled. 35 of 50 patients applied lymphatic mapping using carbon nanoparticles as the tracer. The sensitivity, specificity, false positive rate and false negative rate were calculated according to the number of lymph nodes, lymph node staining and metastasis, and the effect of lymph node tracer carbon nanoparticles on the lymph node metastasis was evaluated. All patients underwent D2 radical operation with the dissection of the subgroup No.8p lymph nodes. the relationship between the metastasis of lymph nodes or subgroup No.8p lymph nodes and clinic pathologic features were analyzed by X2-test.ResultIn our study, Lymphatic mapping was applied in 35 of 50 patients, the success rate, the sensitivity, specificity and false negative rate were 97%, 28%, 62% and 72%respectively. The metastasis of lymph nodes was correlated to the T stage(p=0.004<0.05), the metastasis of No.8p lymph nodes was correlated to the N stage(P=0.007<0.05). 6 cases had lymph node metastasis in subgroup No.8p, the TNM stage and clinical stage were as follows: T1N2M0 ⅡA, T3N3M0 ⅢB, T4aN3M0ⅢC, T4aN3M0 ⅢC, T4aN3M0 ⅢC, T4bN3M0 ⅢC.ConclusionAs the lymph node tracer, carbon nanoparticles did not prove that it has good selectivity for metastatic lymph nodes. In our study, the result of lymphatic mapping didn’t achieve a satisfactory performance which still needs further study.The metastasis of lymph nodes was correlated to the T stage. There was no significant difference between lymph node metastasis and tumor size, tumor location,tissue type and Bormann type, because of the lack of sample size.The metastasis of No.8p lymph nodes was correlated to the N stage, for patients with N stage more than N2, we suggest the dissection of the subgroup No.8p lymph nodes.更多还原