贲门癌手术中淋巴结廓清范围的探讨

Investigate on rational lymph-node dissection for gastric cardia cancer

目的探讨贲门癌淋巴结转移规律及其手术中合理的清扫范围。方法回顾性分析1999年1月至2004年12月间77例贲门癌患者的临床病理学资料。比较淋巴结的不同清扫范围对患者预后的影响。结果（1）本组77例贲门癌患者临床分期以Ⅲ、Ⅳ期为主，共计57例（74．0％），可进行检索的淋巴结转移率：N1 64．9％，N2 14．3％，N3 10．4％；（2）T1及肿瘤最大径小于2．0cm时未检测到淋巴结转移，T2N（＋）1／5，T3N（＋）68．2％，T4N（＋）80．8％；（3）N1主要集中在No．1、3、2组，N2主要集中在No.7、8、10、9组，N3分别为No．5组6．5％、No．6组1．3％、No．16组1．3％、No．107～110组2．6％；（4）不同淋巴结清扫范围者的5年生存率：D1为22．7％，92为31．3％，D2为36．5％，D2、D3与D1术后生存率比较，P〈0．05，差异有统计学意义。结论对进展期贲门癌患者行D2以上淋巴结廓清术。可满足根治性要求，有延长生存时间的作用。

Objective To investigate the rude of lymph-node metastasis in gastric cardia cancer and the rational extent of lymph node dissection. Methods Clinicopathological data of 77 patients with gastric cardia cancer were reviewed and the relationship between extent of lymph-node dissection and prognosis was analyzed retrospectively. Results （1）The lymph node metastasis rates were 64.9% for N1, 14.3% for N2 and 10.4% for N3. （2） No lymph node metastasis was detected in T1 stage tumor and maximum diameter of less than 2.0 cm. The lymph node metastasis rates were 20% for T2, 68.2% for T3 and 82.8% for T4 respectively. （3）Lymph node No.l, 3, 2 were often involved in the metastasis of lymph node group 1, and No,7, 8, 10, 9 in Group 2. In lymph node group 3, lymph node metastasis rates were 6.5% for No.5, 1.3% for No.6, 1.3% for No.16 and 2.6% for No.107-110. （4）The five-year survival rates were 36,5% for D3, 31.3% for D2, and 22.7% for D1 lymphadenectemy respectively. The survival rates of patients undergone D2 and D3 lymphadenectomy were significantly higher than that undergone D1 dissection （P〈0.05）. Conclusion D2 or more than D2 lymphadenectomy associated with enlargement of esophageal hiatus via laparotomy, lower partial esophagectomy and total gastrectomy is able to achieve surgical resectability and improve the survival rate of gastric cardia cancer patients.