| Background:Gastric cancer is the most common carcinoma in the world and in our country, and in our country, the mortality of gastric cancer is the highest among all kinds of carcinoma. At present, surgical operation still is the most effective treatment for gastric cancer, but extended lymph node dissection, for those with negative lymph node metastasis is not necessary, also it can enhance the insult to the patient and increase the complications and the mortality of operation. Therefore, we need an effective method to evaluate the lymph node metastasis to direct the extent of lymph node dissection. And sentinel lymph node biopsy is such a kind of technique. SLNB is a new kind of technique developed in recent years, which can clearly predict the metastasis status of lymph nodes. Thus patients with negative lymph node metastasis can avoid usual extended lymph node dissection. It has been applied to the treatment for breast cancer, pile cancer, thyroid cancer, squamous cancer in head and neck, and some other kind of carcinoma, at present the application of this technique to gastric cancer is only reported by some Japanese researchers.Objective:This research was designed to evaluate the applicability of sentinel lymph node biopsy in gastric cancer treatment through applying this technique to 38 cases of patients of gastric cancer.Methods:The 38 patients are divided into 3 groups according to the post-operation pathological examination of the dissected specimen: T1 13 cases, T2 17 cases, and T3 8 cases. Those with distal metastasis, invasion of neighboring organs, history of abdominal operation, and obesity were excluded from this research. The method of biological dye is used to locate the sentinel lymph node during operation: after the incision of peritoneal cavity, Methylene blue was injected to the subseroal layer at 4 different sites around the primary tumor, each site with 0.1-0.2ml and the total dose is 0.5-0.8ml. After the injection, the blue-stained lymph vessel can be observed and alongwith the lymph vessel some blue-stained lymph node can be detected, and the blue-stained lymph nodes that appear first will be defined as sentinel lymph node. After the operation, all sentinel lymph nodes (SLN) and non-sentinel lymph nodes (NSLN) were subjected to HE stain and Immunohistochemistrical stain, using Sreptavidin -Peroxides technique, and 9 cases was examined by the method of frozen section. The dissected stomach was subjected to normal pathological examination to determine the depth of the tumor invades.Results:SLN have been detected in all 38 patients, and the detection rate is 100%. In all 38 cases. 86 SLN were detected, each case with 1-4, and 693 nodes were found after operation. So in all 779 nodes were checked. The method of HE stain detected 16 case with lymph metastasis in all 38 cases .and 58 nodes with metastasis, so the lymph metastasis is 42.11% (16/38) and the lymph metastasis degree is 7.45% (58/779) ;As so as the method of Immunohistochemistrical stain was concerned , the lymph metastasis is 47.37% (18/38) and the lymph metastasis degree is 11.17% (87/779) .The difference between the two the lymph metastasis degree is significant (X2=6.26 0.025 |
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