胃癌淋巴结转移规律及其清扫范围探讨

Lymph node metastasis and extent of lymph node dissection for gastric cancer

目的 探讨胃癌淋巴结转移规律及其清扫范围。方法 对188例接受手术治疗的胃癌患者,于术中用美蓝-胃癌单克隆抗体(MAb)3H11标记淋巴结,并对染色淋巴结进行清扫,术后统计切除标本的淋巴结转移情况及病理特征。结果 188例胃癌患者的淋巴结转移率为62.8％(118／188)。胃上1／3(U区)、中1／3(M区)、下1／3(L区)及全胃癌患者的淋巴结转移率分别为61.9％、60.0％、57.5％及95.0％。早、中、晚期胃癌患者淋巴结转移率依次呈递增趋势,P<0.05。浸润型(Ⅲ、Ⅳ型)转移率(76.1％)明显高于局限型(Ⅰ、Ⅱ型)(44.3％),P<0.05。肿瘤直径≤4cm、-7cm和≥8cm者的淋巴结转移率依次增加,差异有显著性,P均<0.01。结论 胃癌淋巴结转移率较高。尤其晚期、浸润型及直径>4cm的胃癌,其淋巴结转移率更高,术中应按胃癌的临床病理分期、部位、大小及Borrman分型,选择淋巴结清扫范围。如果根据术中美蓝-MAb3H11标记结果确定淋巴清扫范围将更准确可靠。

Objective To investigate the lymph node metastasis and the extent of lymph node dissection for gastric cancer. Methods The lymph nodes in 188 patients with gastric cancer were marked intraoperatively with methylene blue and monoclonal antibody(MAb)3H11,and were analyzed after curative gastrectomy. Results The total rate of lymph node metastasis was 62. 8%. The lymph node metastasis of upper,middle,lower region and the whole stomach were 61. 9%, 60. 0%,57. 5% and 95. 0%respectively. The rate of the lymph node metastasis increased successively in carcinama of early,middle and late stage, P<0. 05. The rate of the lymph node metastasis of the infiltrative tumor (Ⅲ,Ⅳ) being 76. 1%, which was significantly higher than that of the circumscribed tumor(Ⅰ ,Ⅱ)(44. 3%),P<0. 05. Relating with the tumor size≤4cm in diameter showed lesser rate,while -7cm and≥8cm in diameter showed increasingly higher metastaticrate,P<0. 01. Conclusions The rates of the lymph node metastasis was higher,especially higher in carcinoma of late stages,the infiltrative tumor and tumor size > 4cm in diameter, the appropriate extent of lymph node dissection should be decided by clinicopathological stages, type of Borrmann' s, site and size of gastric cancer. It should be more accurate if according to the results of marking intraoperative with methylene blue and MAb3H11.