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胃癌的治愈(切除)和非治愈(切除)的判断是由胃癌是否累及腹膜(P)、肝(H)、淋巴结(N)、邻近脏器(S)、上下切缘(OW/AW)等因素决定的。现在公认决定胃癌的非根治因素有OW、AW、P(+)(P_1、P_2、P_3)、H(+)(H_1、H_2、H_3),N_4(特别是主动脉周围的第16组淋巴结)、远隔脏器转移(肺、骨)。另外还有腹水阳性C(+)和S_3。1.OW、AW为了使手术切缘不残留癌细胞,术前必须明确癌的浸润范围和诊断多发癌。龟田报告采用色素内镜(刚果红甲胺蓝试验)能术前诊断表面平坦型早期胃癌Ⅱb和小于1cm的典型Ⅱc癌的浸润范围。方法是在常规胃镜后在内镜直视下,向整个胃粘膜做0.05%甲胺蓝喷雾,并仔细观察胃粘膜面。然后加喷0.3%刚果红0.2M重曹溶液,观察甲胺蓝色素的吸收情况。再进一步肌注胃泌素(5μg/kg)观察胃酸分泌。可见分泌胃酸粘膜刚果红色素变成蓝黑色,称
Whether gastric cancer is cured (removed) or non-healed (removed) is judged by whether gastric cancer affects the peritoneum (P), liver (H), lymph nodes (N), adjacent organs (S), upper and lower margins (OW/AW), etc. Factors determine. It is now generally accepted that the non-curative factors determining gastric cancer include OW, AW, P(+) (P_1, P_2, P_3), H(+) (H_1, H_2, H_3), and N_4 (especially the 16th group of lymph nodes around the aorta). Distant organ transfer (lung, bone). There are also ascites positive C (+) and S_3. 1. OW, AW in order to make surgical margins do not leave cancer cells, preoperative cancer must be clear invasive range and diagnosis of multiple cancers. Kameida reported that the use of pigmented endoscopy (congo red amine blue test) can be preoperative diagnosis of a flat surface type of early gastric cancer IIb and less than 1cm typical IIc cancer infiltration range. The method is to perform a 0.05% methylamine blue spray to the entire gastric mucosa under conventional endoscopy, and observe the gastric mucosa surface carefully. Then add 0.3% Congo red 0.2M heavy Cao solution to observe the absorption of methylamine blue pigment. Further intramuscular gastrin (5 μg/kg) was observed for gastric acid secretion. Visible secretion of gastric acid Congo red pigment into blue and black, said