进展期远端胃癌淋巴结转移特点与D2术式的应用

Advanced distal gastric cancer lymph node metastasis with D2 lymphadenectomy application

目的探讨进展期远端胃癌淋巴结转移特点,以指导进展期远端胃癌淋巴结的清扫范围。方法收集D2或D2以上、清扫淋巴结在15枚以上的根治性手术治疗的51例进展期远端胃癌临床病理资料,分析其淋巴结转移特点及其与根治性手术关系。结果51例进展期远端胃癌总的淋巴结转移率为72.6%(37/51),其中第Ⅰ站有转移而无第Ⅱ、Ⅲ站及远处淋巴结转移的淋巴结转移率为35.3%(18/51),第Ⅰ、第Ⅱ站有转移而无第Ⅲ站和远处淋巴结转移的淋巴结转移率为66.7%(34/51);第Ⅲ站淋巴结有转移的转移率为3.9%(2/51),远处淋巴结有转移的转移率为2.0%(1/51)。第Ⅰ站No.6淋巴结转移率最高为37.3%(19/51),第Ⅱ站No.8 a+No.12 a转移率明显高于No.1+No.14v、No.1+No.11p,No.7+No.14v、No.7+No.11p,No.9+No.14v、No.9+No.11p(P<0.01)。No.8 a+No.12 a转移率与No.8 a+No.14v、No.8 a+No.11p比较差异无统计学意义(P>0.05)。结论大部分进展期远端胃癌外科治疗以D2术式淋巴结清扫范围较合理,部分进展期远端胃癌的术式选择与淋巴结清扫范围有待进一步研究。

Objective To investigate the lymph node metastasis for the extent of lymph node dissection in advanced distal gastric cancer. Methods A total of 51 advanced distal gastric cancer clinicopathological datas were collected, which underwent D2 lymphadenectomy or over, and lymph node dissection were more than 15 lymph nodes. The lymph node metastasis feature relation with radical operation were analyzed. Results The total rate of lymph node metastasis was 72.6% （ 37/51 ）. Metastasis to the first leg of lymph nodes, but none to the second leg or the third leg or farther lymph nodes were 35.3% （ 18/51 ） ; metastasis to the first leg, the second leg lymph nodes, but none to the third leg or farther lymph nodes were 66.7% （34/51） ; metastasis to the third leg of lymph nodes were 3.9% （2/51） ; metastasis to distant place lymph nodes were 2.0% （ 1/51 ）. The metastases rate （37.3%） of No. 6 group lymph node was the highest in the first leg of lymph nodes. The metastases rate of No. 8a ＋ No. 12a was higher than No. 1 ＋ No. 14v, No. 1 ＋ No. 1 lp, No. 7 ＋ No. 14v, No. 7 ＋ No. 1 lp, No. 9 ＋ No. 14v, No. 9 ＋ No. 11p（ P 〈 0. 01 ）. The metastases rate of No. 8a ＋ No. 12a was not significantly different from that of No. 8 a ＋ No. 14v, No. 8 a ＋ No. 11 p （ P 〉 0.05 ）. Condusion 132 lymphadenectomy is more reasonable for mostly advanced distal gastric cancer, some still for further study.