全胃根治性切除术中保留脾脏的脾门淋巴结清扫的临床应用

Feasibility and safety of splenic hilar lymphadenectomy with spleen preservation in radical total gastrectomy for gastric carcinoma

目的探讨全胃根治术中保留脾脏的脾门淋巴结清扫的可行性及安全性。方法回顾性分析我院2007年1月至2011年3月间76例全胃根治性切除治疗胃中上部及全胃癌患者的临床病理资料,比较保脾组与切脾组患者脾门淋巴结清扫数及转移率情况。结果保留脾脏组患者40例,脾切除组36例,两组患者间,男女性别比、肿瘤部位、淋巴结清扫程度、TNM分期无显著性差异(P>0.05)。保留脾脏组和脾脏切除组No.10组脾门淋巴结转移度分别为12.2%(16/131)、11.5%(14/122),两组患者No.10组脾门淋巴结转移率分别为15.0%(6/40)、19.4%(7/36),两组间No.10组脾门淋巴结转移度及患者转移率无显著性差异(P>0.05)。保留脾脏组平均每例患者脾门淋巴结清扫(3.25±1.57)枚,脾脏切除组平均每例脾门淋巴结清扫(3.39±1.40)枚,差异无统计学意义。结论全胃切除根治术中保留脾脏的脾门淋巴结清扫切实可行,外科医生应努力提高手术技巧,减少无辜性脾切除。

Objective To investigate the feasibility and safety of splenic hilar lymphadenectomy with spleen preservation in radical total gastrectomy for gastric carcinoma.Methods The clinical data of 76 gastric cancer patients who underwent radical total gastrectomy from January 2007 to March 2010 in our hospital were analyzed retrospectively.The clinicopathological parameters including tumor location,extent of lymphadenectomy,TNM stages,and the number of No.10 group lymph nodes dissected were compared between the spleen preservation group and splenectomy group.Results Splenic hilar lymphadenectomy with spleen preservation was performed in 40 cases,while splenectomy or splenectomy plus resection of pancreatic body and tail in 36 cases.There were no significant differences in sex,tumor location,extent of lymphadenectomy and TNM stages between the two groups(P>0.05).The metastatic lymph node ratios of the spleen preservation and splenectomy goups were 12.2%(16/131)and 11.5%(14/122),and the lymph node metastatic rates of the patients were 15.0%(6/40)and 19.4%(7/36).There were no significant differences in metastatic lymph node ratio and lymph node metastatic rate of the patients between the two groups(P>0.05).The mean number of splenic hilar lymph nodes harvested was(3.25±1.57) in spleen preservation group,(3.39±1.40) in splenectomy group respectively,and no difference was found between the two groups(P=0.71).Conclusions Spleen-preserving splenic hilar lymphadenectomy is a feasible and safe method to accomplish radical lymphadenectomy in total gastrectomy for gastric carcinoma.Surgeons should master excellent surgical techniques to perform anatomical lymph node dissection and unnecessary splenectomy be avoided.