进展期胃癌对胃周围血管鞘的影响

Effect of advanced gastric cancer on vagniae vasorum of gastric vessels

目的探讨胃癌发展转移过程中对胃周围动脉血管鞘的影响，为胃癌的外科治疗提供依据。方法收集2004年4月至2005年2月经外科治疗的各期胃癌患者59例共计包括血管鞘的胃左和（或）胃右动脉标本107份（胃左动脉55份，胃右动脉52份），采用冰冻切片，并应用苏木精。伊红染色、酶组织化学及免疫组织化学的方法对标本进行染色。结果Ⅰ、Ⅱ期胃癌没有发现有癌细胞转移至血管鞘内，进展期胃癌血管鞘内和（或）鞘上发现转移的癌细胞或癌细胞簇，包括2例Ⅲ期胃癌患者的4份标本和12例Ⅳ期胃癌患者的22份标本。107份血管鞘上的毛细淋巴管被5′核甘酸酶染成棕褐色，被碱性磷酸酶染成蓝色的血管鞘上毛细血管有101份，两种结构随着肿瘤的进展数目增多，密度增大（均P=0．000）。结论对于Ⅱ期以上的进展期胃癌根治术需要采用血管鞘内分离以彻底清扫动脉周围组淋巴结。

Objective To explore the effect of advanced gastric cancer on vagniae vasorum of gastric vessels. To provide evidence for the surgical treatment of gastric cancer. Methods The study included 107 specimens of left and right gastric arteries （55 left and 52 right ） from 59 patients who underwent radical gastreetomy for carcinoma. All specimens were dealt with frozen section method, then they were stained with HE, enzyme histoehemieal method and immunohistochemieal method, respectively. Results Metastatic cancer cells or tubercles were found inside vagina vasorum in some stage Ⅳand Ⅲ specimens. Cytokeratin positive of tumor cells in or on vagina vasorum was showed on 26 slices from 14 tumors. Among them, 4 slices from 2 tumors belonged to stageⅢ, and 22 slices from 12 tumors belonged to stage Ⅳ. Observed under light microscope, the lymphatic capillaries within vagina vasorum were dark brown with 5′-nucleotidase staining in 107 specimens,the capillary tubes within vagina vasorum were blue with alkaline phosphatase staining in 101 specimens. The two structures changed with the development of gastric carcinoma. Average area and bulk density of lymphatic vessel vaginae vasorum were associated with TNM staging of gastric cancer（P=0.001 and P=0.004）. Conclusion Vaginae vasorum dissection, which may not be applied for early gastric cancer, is recommended when clearing lymph nodes around arteries in radical gastrectomy for carcinomas in stage Ⅱ and above.