进展期胃窦癌淋巴结转移分析

Lymph node metastasis analysis of advanced gastric antral cancer.

目的 探讨进展期胃癌根治术的淋巴结清扫范围。方法 对1988～2002年243例施行根治术(D2、D2 )的进展期胃窦癌患者的病理检查进行回顾性分析。结果 本组淋巴结转移率72.8%。BorrmannⅠ、Ⅱ、Ⅲ、Ⅳ型淋巴结转移率分别是42.9 %、47.6%、85.1%、100.0%。Ⅰ、Ⅱ型与III、IV型淋巴结转移有显著性差异(p<0.01);Ⅲ、Ⅳ型淋巴转移距离远 ,N3站淋巴结转移率26.4%。T2和T3、4 患者淋巴结转移率分别为40 %和80.3% ,N3站淋巴结转移分别为2.2 %和20.7% ,亦有显著性差异 ( p<0.01)。转移淋巴结小结节型和一般型转移范围较广泛 ,N3 站淋巴结转移率分别为35.5 %和20.0%。在N3 站转移的患者中以No(12、13) 转移率最高(16.9 %、11.9%)。结论 对进展期胃窦癌 ,BorrmannⅢ、Ⅳ型 ,T3、T4 者 ,转移淋巴结小结节型或一般型患者 ,胃癌根治术应施行D3淋巴结清扫 ;No(12、13) 清扫应纳入标准D2

Objective To explore the extent of lymph node resection of radical operation in gastric antral cancer. Methods From1988to2002,243patients who had radical operation duo to advanced gastric antral cancer were analyzed retrospectively. Results Local lymph node Metastasis(LNM)was72.8%.The rate of LNMwas significantly different between Borrmann I andⅡ.The LNMextent of Borrman III andⅣmay be more extensive and26.4%patients had N3station lymph node metastasis.LNMof T 2 and T 3 in 4 patients were40%,80%,and N 3 station LNMwas2.2%,20.7%,respectively and there was also significant difference(p<0.01).The LNMof small nodule type and general type would be more extensively and the rates of N3station lymph node metastasis were35.5%and20.0%respectively. Conclusion D 3 operation should be performed in patients with Borrmann III,Ⅳ,T3,T4,small nodule type and general type of advanced gastric antral cancer and No (12,13) lymph node dissection should be routine to standard D 2 operˉation.