胃癌孤立性淋巴结转移状况与手术范围的关系

Relationship between the situation of solitary lymphatic metastasis and radical dissection in gastric carcinoma

目的 研究胃癌孤立性淋巴结分布规律及临床意义，指导手术范围。方法 回顾51例胃癌孤立性淋巴结转移病人的临床病理资料，分析孤立性淋巴结转移出现部位及与原发癌灶的关系，比较跳跃式转移和非跳跃式转移两组病例的临床病理特征。结果 发生在胃周（N1）区域孤立性转移淋巴结占74．5％（38例／51例）（非跳跃式转移），其中有39．2％（20例／51例）发生在邻近原发癌灶（N1）处，有35．3％（18例／51例）发生在相对较远离原发癌灶（N1）处，以No．6、3组常见；有25．5％（13例／51例）出现在N2-N3站区域（跳跃式转移），N2站区域为11例，N3站区域为2例，以No．7、8a组为常见。跳跃式转移与肿瘤浸润深度、大小及部位有显著相关性。两组生存率之间的差异均无统计学意义。结论 胃癌孤立性转移淋巴结分布以胃周为主，呈随机性和多向性。跳跃式转移与肿瘤浸润深度、大小及部位有关。

Objective To study solitary lymphatic metastasis and its clinical features in gastric carcinoma for directing the extent of dissection. Methods Clinicopathological datas of 51 cases with gastric carcinoma proved to shar solitary lymph node metastasis were analyzed retrospectively. The location of the solitary metastatic node was examined and its correlation with the site of primary tumor was studied. Clinicopathological features were compared between the skip metastasis group and the non-skip group. Results The solitary metastatic node was detected in the perigastric area （ N1） in 74.5% of all cases. The distribution rate of metastatic node was 39.2%, and in the nearest perigastric nodal area 35.3% in a fairly remote peri-gastric area. In non-skip metastasis group, the solitary metastatic node was usually found in No. 6 and No. 3 group. The solitary metastatic node was detected in the peri-gastric area （ N2 - N3 ） without N1 involvement in 25.5% of all cases. There were 13 cases in skip metastasis group, in which 11 cases Were in the N2 nodes and 2 cases in N3 nodes. In skip metastasis group, the solitary metastatic node was commonly found in No. 7 and No. 8a group （ both in N2 nodes ）. Jumping solitary node involvement was statistically correlated with the degree of wall invasion, the size, and the location of the tumor. There was no statistical difference between the survival rates of skip and non-skip groups. Conclusion Solitary metastatic node is mainly in the peal-gastric region, and its distribution demonstrates a random and multidirectional type. Skip solitary node metastasis may be correlated with the depth of invasion, the size and the location of the tumor.