早期胃癌临床病理特征及手术范围的探讨

Clinicopathological features and surgical treatment of early gastric cancer

作者回顾性地分析了１２６例早期胃癌（ＥＧＣ）患者的临床病理特征。结果：癌肿浸润至胃粘膜内或粘膜下层者的淋巴结率分别为３．１％（２／６５）和１６．４％（１０／６１）（Ｐ＜０．０５）；２６例微小胃癌或小胃癌无一例发生淋巴系转移，余１００例ＥＧＣ的淋巴系转移率高达１９％（Ｐ＜０．０５）。无淋巴系转移者５年生存率为９７．２％，明显高于有淋巴系转移者７９％（Ｐ＜０．０１）。作者认为Ｄ２术应为根治ＥＧＣ的标准术式，特别适用于浸润至粘膜下层或体积较大的肿瘤；Ｄ１术适用于粘膜内癌或小胃癌；Ｄ３术仅适用于某些多灶性、表浅扩散型ＥＧＣ或伴有第三站淋巴结转移者。

AbstractWe analyzed retrospectively the clinicopathologicaldata obtained from 126 patients with early gastric can-cer(EGC)to elucidate the relationship between patho-logical patterns and lymphatic metastasis and the crite-ria of selecting appropriate surgery.Lymph nodemetastasis was 3.1%(2/65)in mucosal and 16.4%(10/61)in submucosal tumors respectively(P<0.05). 26 patients with tumors smaller than 10 mmhad no lymphatic metastasis, and 100 patients with tu-mors larger than 10mm in size had 8%(8/100) n_1posi-tive,4%(4/100) n_2 postitive and 7%(7/100)lym-phatic duct invasion(P< 0.05)。The 5-vear survivalrate in patients with lymphatic metastasis(79%,15/19)was significantly lower than that in patients with-out lymphatic metastasis(97.2%,104/107)(P<0. 01).It seemed that the most important prognosticfactor is whether the presence of lymphatic metastasisor not,Lymphadenectomy is expected to improve thesurvival rate in EGC, D2 procedure is generally recom-mended as a standard operation for EGC,especially forthe submucosal or larger lesion. Anyhow,D1 opera-tion is sufficient for mucosal or smaller cancer,and D3is suitable only for EGC patients with multifoci,super-ficially spreading type and group 3 lymph node metas-tasis.