对胃癌手术中不同淋巴结清除术的合理评价

Rational evaluation of different lymph node dissection

行胃癌根治切除术３７１例，对其不同淋巴结清除术（Ｄ＿１、Ｄ＿２、Ｄ＿３）作了疗效评价与适应证探讨。结果表明，Ｉａ期胃癌行Ｄ＿１或Ｄ＿１式淋巴结清除术即可；Ｉｂ期胃癌行Ｄ＿２式清除术为宜；ＩＩ＋ＩＩＩ期限局型或团块状生长胃癌，Ｄ＿３、Ｄ＿２比Ｄ＿１式清除术为佳。ＩＶ期此型胃癌，Ｄ＿３＋Ｄ＿２式清除术后５年生存率尚可达４２．９％；然而，ＩＩ＋ＩＩＩ期浸润型、弥漫状生长者，Ｄ＿３、Ｄ＿２式清除术也难明显提高疗效。淋巴结无转移者不必行扩大清除术。淋巴结少数转移或第１站转移者，Ｄ＿３、Ｄ＿２式清除术为佳。多数转移或第２站转移者，Ｄ＿３比Ｄ＿２、Ｄ＿１式为佳，广泛转移（１０个以上或第３站转移）者，Ｄ＿３、Ｄ＿２式清除术疗效亦较差。

o evaluate the effect and indication of diffferentlymph node dissection (D1 . D2 .D3) , we perfermed radi-cal operations for 3il cases of gastric cancer. The re-sults showed that D1 or D1 lymph node dissection wasenough for gastric cancer of ia stage, D2 was suitable forIb stage. For localized or massive type gastric cancer ofⅡ+Ⅲ stage, D3, D2 dissection was better than D1 dis-section. For the gastric cancer of the same type in Ⅳstage. the 5-year survival rate after D3 +D2dissectionwas 42. 9% , but for the gastric cancer of infihrativetype or diffused growth pattern in Ⅱ+Ⅲ stage, the ef-fect was not significantly increased even after the D3 ,D2dissection. For the gastric cancer of this type in Ⅳstage, the effect was not improved after the extendedlymph node dissection. Extended dissection needn’t beperformed if there was no lymph node metastasis. D3,D2 dissection was better if there was little lymph nodemetastasis or the metastasis was limited to lst group.For those metastasized to 2nd group or the quantity wasmore , D3 was better than D2 ,D1. The effect of D3, D2dissection was not significantly improved in the exten-sive metastasis case (more than 10 or to the 3rd group).