早期胃癌行前哨淋巴结导航手术的实践与思考

doi:10.19723/j.issn.1671-167X.2026.02.002

摘要/Abstract

摘要：

伴随微创技术、人工智能和大数据不断更新迭代，早期胃癌的外科治疗逐步进入个体化、精准化、智能化时代，以前哨淋巴结导航手术为代表的保功能手术逐步成为早期胃癌的主流术式选择，但是前哨淋巴结导航手术在前哨淋巴结定义、示踪剂选择、显影时间、手术范围和策略、病理学检查及术后补充根治手术指征等方面尚存争议。基于当前的研究现状和实践经验，建议基于淋巴结转移规律和示踪剂显影情况综合判断前哨淋巴结区域，从而重新定义早期胃癌前哨淋巴结；建议选择吲哚菁绿作为早期胃癌前哨淋巴结导航手术的示踪剂，吲哚菁绿显影时间的界定仍需开展进一步研究予以证实；关于术中切缘冰冻病理检查，需要注意胃黏膜的完整留取，尽量避开超声刀或电刀的烧灼缘；关于术中前哨淋巴结冰冻病理检查，建议根据淋巴结短径是否超过4 mm采取不同的取材方式；同时基于前期的实践经验，在前哨淋巴结清扫策略、胃局部切除范围和策略及术后补充二次手术指征等方面提出了我们团队的建议，未来仍需开展高质量循证医学研究验证前哨淋巴结导航手术的安全性和有效性，进而提高我国乃至全球的早期胃癌外科治疗水平。

关键词: 早期胃癌, 前哨淋巴结导航手术, 胃局部切除, 安全性, 有效性

Abstract:

With the continuous update and iteration of minimally invasive techniques, artificial intelligence and big data, the surgical treatment of early gastric cancer has gradually entered an era of indivi-dualization, precision and intelligence. Function-preserving surgeries represented by sentinel lymph node navigation surgery have gradually become the mainstream surgical options for early gastric cancer. How-ever, a great deal of controversy remains in sentinel lymph node navigation surgery regarding the definition of sentinel lymph nodes, the selection of tracers, the time of visualization, the scope and strategy of surgery, pathological examination, and the indications for supplementary radical surgery after surgery. Based on the current research progress and practical experience, it is suggested to comprehensively determine the sentinel lymph node area based on the lymph node metastasis pattern and the tracer imaging situation, thereby redefining the sentinel lymph nodes of early gastric cancer; It is recommended to select indocyanine green as the tracer for sentinel lymph node navigation surgery in early gastric cancer, and the definition of the imaging time of indocyanine green still needs further research for confirmation; Regarding the intraoperative frozen pathological examination of the incision margin, it is necessary to pay attention to the complete preservation of the gastric mucosa and try to avoid the ablation margin of the ultrasonic scalpel or electrocautery; Regarding the frozen pathological examination of sentinel lymph nodes during the operation, it is recommended to adopt different sampling methods based on whether the short diameter of the lymph nodes exceeds 4 mm; Based on the previous practical experience, our team has put forward suggestions in aspects such as the sentinel lymph node dissection strategy, the scope and strategy of local gastrectomy, and the indications for supplementary surgery after initial surgery. Therefore, high-quality evidence-based medical research is still needed to verify the safety and effectiveness of sentinel lymph node navigation surgery, thereby improving the surgical treatment level of early gastric cancer in China and even globally.

Key words: Early gastric cancer, Sentinel lymph node navigation surgery, Local gastrectomy, Safety, Effectiveness

中图分类号:

R735.2

步召德, 冯梦宇, 季科. 早期胃癌行前哨淋巴结导航手术的实践与思考[J]. 北京大学学报（医学版）, 2026, 58(2): 239-243.

Zhaode BU, Mengyu FENG, Ke JI. Practice and reflection on sentinel lymph node navigation surgery for early gastric cancer[J]. Journal of Peking University (Health Sciences), 2026, 58(2): 239-243.

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