| Objective : To explore the detection rate of sentinel lymph nodes(SLN)and the accuracy,sensitivity,specificity,positive predictive value and negative predictive value of regional lymph node metastasis in patients with gastric cancer by using indocyanine green(ICG)staining to trace SLN,and to explore the application of ICG in regional lymph node tracing in radical resection of gastric cancer and its clinical significance in regional lymph node dissection.Methods:The clinical data of 80 patients with gastric cancer in 1st ward(gastroenterology)of oncology department of The Affiliated Hospital of qinghai university from May 2018 to September 2019 were analyzed retrospectively.All patients diagnosed as gastric cancer for certain by preoperative gastroscopic biopsy were randomly divided into experimental group(n=40)and control group(n=40).The patients in the experimental group were injected with different injection methods according to different preoperative tumor stages.When the preoperative stage was early and the location of the tumor was not easy to distinguish,ICG was injected under endoscope 30 min before operation.After rapid exploration during the operation,the lymph nodes colored by fluorescence laparoscopy were picked up.When the preoperative stage was late,ICG(produced by Dandong Medical and Chuang Pharmaceutical Co.,Ltd.)was injected around the tumor at four points during the operation(0.5ml per point,a total of 2ml),and SLN detection was performed 10 min later.The luminous lymph nodes under fluorescence laparoscopy were defined as SLN,and the luminous lymph nodes were picked up by the operator,fixed in a sample bag and sent for examination.After operation,the remaining specimens were dissected by the surgeon to detect the regional lymph nodes of the tumor as much as possible,while the control group was not injected with ICG.Laparoscopic radical resection of gastric cancer was performed by the same operator.The lymph nodes were collected after operation and sent to the pathology department for HE staining for pathological analysis.The accuracy,sensitivity,specificity,positive predictive value and negative predictive value of ICG for SLN tracing were calculated,and the number of lymph nodes in the two groups was counted.The results of lymph node dissection were compared and the postoperative complications were recorded.Result:No discomfort was found in 40 patients in the experimental group after injection of ICG.SLN were detected under fluorescence laparoscopy,with a detection rate of 100%(a total of 60 SLN were detected,with an average of 1.5 per patient).Postoperative pathology showed that 22 patients had regional lymph node metastasis,of which 20 patients were positive for SLN.There were 2 cases of non-SLN metastasis.the sensitivity,accuracy,specificity,positive predictive value and negative predictive value of predicting perigastric lymph node metastasis by SLN were 90.9%,95%,100%,100% and 90%,respectively.A total of 1242 lymph nodes were detected in the experimental group,with an average of(31.05±8.73)lymph nodes per patient;a total of 1003 lymph nodes were detected in the control group,with an average of(25.08±8.32)lymph nodes per patient.The average number of lymph nodes in the experimental group was higher than that in the control group(P<0.05).There were 93 cases(7.48%)of positive lymph nodes in the experimental group,and 70 cases(6.97%)of positive lymph nodes in the control group.There was no significant difference in the number of positive lymph nodes between the two groups(P>0.05).Conclusion:1.Indocyanine green(ICG)has high accuracy and sensitivity in tracing SLN of gastric cancer,which can increase the detection of SLN and can be used for routine SLN biopsy of gastric cancer.2.For laparoscopic radical resection of gastric cancer,it is safe and feasible for patients to use ICG before operation,and there is no obvious adverse reaction in the course of the study.The tracer effect can effectively increase the number of lymph node dissection during the operation of gastric cancer,so as to achieve the purpose of radical treatment,and play a positive guiding role in evaluating the postoperative stage and treatment of patients. |
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