胃癌D2式淋巴结清除术的临床研究

Clinical study of D2 lymphadenectomy for gastric cancer

目的:分析D2式淋巴结清除术对胃癌患者的预后、手术并发症和死亡率的影响。方法:对217例胃癌手术患者进行前瞻性研究,随机分成对照组(108例胃癌患者进行D0/D1式淋巴结清除术)和实验组(109例胃癌患者进行D2式淋巴结清除术),术后病理确诊分期,对比两组的有效率和不良反应发生率。结果:本组患者不同分期的5年生存率实验组:对照组分别为Ⅰ期90%(27/30)∶87.8%(29/33),P=0.878;Ⅱ期89.7%(35/39)∶47.2%(17/36),P=0.003;Ⅲ期52%(13/25)∶18.2%(4/22),P=0.008,Ⅳ期6.6%(1/15)∶5.8%(1/17),P=0.474。D2∶D0/D1术后总并发症发生率分别为27.5%∶21.3%,P=0.302,其中D0/D1、D2的手术死亡率均为0。结论:胃癌的D2式广泛性淋巴结清除术是安全的,能够显著地改善Ⅱ～Ⅲ期胃癌患者的预后。

OBJECTIVE： To study the operative morbidity and mortality and prognostic benefit of extended lymphadenectomy in the treatment of gastric cancer. METHODS： Two hundred and seventeen patients with primary gastric cancer were randomized into two groups. Control group： 108 patients underwent lymphadenectomy. Test group： 109 patients underwent extended lymphadenectomy. The pathological examinations after the operation confirmed the clinical stages of the patients. The evaluation of the effect and salty was performed after the therapy. RESULTS： The 5-year survival rates of the test group vs the control group were stage Ⅰ 90% （27/30） vs87.8%（29/33）, P=0.878; stage Ⅱ 89.7%（35/39） vs 47.2%（17/36）, P=0.003, stage Ⅲ 52%（13/25） vs 18.2%（4/ 22）, P=0.008; stage Ⅳ 6.6%（1/15） vs 5.8%（1/17）, P=0. 474, respectively. The incidence of the postoperative complications of D2 vs D0/D1 was 27.5% vs 21.3%, P=0. 302, including both the operative morbidity of D0/D1 and D2 were 0. CONCLUSION：The extended lymphadenectomy can be performed safely and provide a survival benefit for patients with gastric cancer, especially in stage Ⅱ - Ⅲ.