101例早期胃癌个体化手术治疗的临床分析

Clinical analysis of early gastric carcinoma in 101 patients

目的研究早期胃癌个体化手术的淋巴结廓清效果。方法回顾性分析按日本胃癌治疗规范进行手术的101例早期胃癌的临床病理资料。结果16例伴有淋巴结转移的早期胃癌,均为下部癌,总的转移率为15.8%,第1站(N1)及第2站(N2)分别为10.9%及4.9%。淋巴结转移主要与肿瘤浸润深度、病灶大小、病理类型有关。黏膜下癌淋巴结转移率为27.9%,明显高于黏膜癌(6.9%,P<0.05)。微小胃癌未见淋巴结转移,小胃癌淋巴结转移率为5.0%,随着肿瘤最大径的增加,1.1～2.0cm及>2.0cm的淋巴结转移率分别增至14.8%及27.5%(P<0.05)。高分化早期胃癌未见淋巴结转移;中分化及低分化的淋巴结转移率分别为17.2%及19.6%。在有淋巴结转移病例中,N1受累频率最高的是第3组淋巴结,受累频率为50.0%,其次为第6,4组及第5组淋巴结,分别为37.5%、31.3%及12.5%;在N2中,第7,8a组及第9组的受累频率依次递减为25.0%、12.5%及6.3%。黏膜癌仅累及N1淋巴结,而黏膜下癌转移至N2的频率明显增高;微小癌无淋巴结受累,小胃癌仅累及到N1淋巴结;而最大径在1.1cm以上的病例,累及N2淋巴结的几率明显增加;高分化早期胃癌未见淋巴结转移,随着分化程度的恶化,N2淋巴结受累的频率亦显著增加。结论早期胃癌的个体化手术治疗,在淋巴结廓清效果上和标准D2根治术是一致的。因此,个体化术式的选择达到了根治、低侵袭及改善患者生活质量的目的。

Objective To investigate the principle of lymph nodes metastasis （LNM） in early gastric carcinoma （EGC） ,and try to provide theoretical basis for individualized treatment. Methods One hundredand one patients were operated upon due to EGC, all clinicopathologic data were analyzed retrospectively. Results LNM was detected in 16 cases with lesion in lower stomach, the incidence of LNM was 15.8%. LNM correlated with depth of infiltration, tumor size and pathological type. The rate of LNM was 27.9% in SM2 ,significantly higher than that in M（2.8% ） and SM（ 13.6% ） ,P 〈0.05. The incidence increased along with the increment of tumor size, no LNM was found in minute gastric cancer （MGC） ,5.0% in small gastric cancer（SGC） ,14.8% in patients with 1.1 -2.0 cm lesion in diameter and 27.5% in greater than 2.0 cm （P 〈 0.05）. Well -differentiated EGC without LNM, whih the risk was 17.2%, 19.6% for moderate - and poor - differentiated respectively. The research showed that, in level Ⅰ tier lymph nodes （LN）, the risk of No. 3 LN involvement reached up to 50.0%, followed by No. 6（37.5% ）, No. 4（31.3% ） and No. 5 （12.5%）. In levelⅡ, the risk decreased gradually hy 25.0%, 12.5% ,6.3% for No. 7,8 a,9 LN respectively. In our series, M and SM1 involved level Ⅰ tier LN, but level Ⅱ tier LN involvement obviously increased in SM2. MGC without LNM, SGC involved level I tier LN only. Nevertheless the rate of level Ⅱ tier LN involvement rose in patients with lesion greater than 1.1 cm in diameter. As the same that, no LNM in well - differentiated cancer, the risk of level Ⅱ increased accompanying the worsening of differentiation. Conclusions The cognition to principh of LNM, especially the EGC in lower stomach, contribute to individualized surgery therapy and offer theoretical support for microinvasive operation.