早期胃癌的临床病理特征及治疗

Clinicopathological features and treatment of early gastric cancer

目的研究早期胃癌(EGC)淋巴结转移规律。方法回顾分析1988年3月～2008年9月手术治疗51例EGC的临床病理资料。结果8例存在淋巴结转移的EGC均为胃下部癌,粘膜下癌淋巴结转移率为23.6%,粘膜癌为10.0%。≤1cm的微小胃癌和小胃癌的淋巴结转移率为7.1%,直径1.1～3.5cm胃癌淋巴结转移率为12.5%,>3.5cm胃癌的淋巴结转移率为60%(P<0.05)。高分化EGC未见淋巴结转移,中分化及低分化癌淋巴结转移率分别为15.3%和20.0%。粘膜下癌可转移至N2。脉管受侵19例,淋巴结阳性率36.8%(7/19),明显高于无脉管受侵者(P<0.05)。结论EGC的淋巴结转移主要与肿瘤浸润深度、病变大小及脉管受侵有关,应根据淋巴结转移的风险合理选择EGC的治疗。

Objective To explore the patterns of lymph mode metastasis （LNM） in early gastric carcinoma （EGC）. Methods between march 1998 and september 2008, elinicopathologic data of 51 eases with EGC who underwent surgery were retrospectively analyzed. Results LNM was detected in 8 cases all from lower stomach carcinoma. The rate of LNM was 23.8 % in submucosal turmors , which was higher than that in mucosal tumors（ 10.0% ）. LNM was 7.1% in minute and small gastric cancer, 12.5 % in patients with carcinoma between 1.1 - 3.5cm and 60% with that larger than 3.5cm （ P 〈 0.05） .Rate of LNM was 15.3% ,20.0% in moderately- differentiated and pcody-differenfiated tumors, respectively, with none in highly-differentiated tumor. It was observed that mucosal tumors involved only level I LN （ N1 ）, while submucosal tumors could spread to level Ⅱ LN （N2）. The rate of LNM in 19 cases with vascular of lymphatic invasion （36.8 % ） was significantly higher that those without vessel in volvement （ P 〈 0. 05 ）. Conclusion Major factors associated with LNM in EGC are tumor infiltration deph,tumor size, and vessel involvement. Surgical treatment of ECG should be based on the consideration of risk of LNM.