进展期胃癌腹膜后淋巴结微转移状况的临床研究

Studies on Para-aortic Lymph Node Dissection for Advanced Gastric Cancer

目的：为提高胃癌根治手术的疗效,阐明胃癌生物学特性与第16组淋巴结转移的关系,探讨腹主动脉旁淋巴结清扫术的指征及此术式的临床可行性。方法：2007年1月～2008年6月对58例无远处转移的进展期胃癌行腹主动脉旁淋巴结清扫术,对反映肿瘤生物学特性的各临床、病理参数进行分析。结果：在58例腹主动脉旁淋巴结清扫术中,发现有第16组淋巴结转移者10例,转移率为17.2%,而于浸润型胃癌、肿瘤直径大于5 cm、肿瘤侵及浆膜以及第2、3站淋巴结受累时,第16组淋巴结转移率明显增高（P〈0.05）;在第16组的各分区淋巴结中又以16A2和16B1区的转移率更高。全组无手术死亡率,手术并发症也未见明显增加。结论：进展期胃癌中有相当一部分发生第16组淋巴结转移,且与胃癌各生物学特性参数相关,只要正确掌握手术适应证,腹膜后淋巴结清扫术也是相对安全、可行的,其对胃癌手术的彻底性和远期疗效的意义有待进一步研究。

Objective：To assess the significance of the para- aortic lymph node dissection in treatment patients with advanced gastric cancer（AGC）, To elucidate the relationship between the para- aortic lymph node （No. 16LN） metastasis and the biological behavior of gastric cancer, To make out the appropriate indications for the para- aortic lymph node dlasection. Methods： 58 cases of AGC without remote metastasis were subjected to the para - aortic lymph node dissection from January 2007 to June 2008 . Clinical pathological studies were carried out for all the cases . Results ：10 of the 58 cases were No. 16LN positive（17.2 96 ） and the positive rate was significantly increased in cases where the tumor was larger than 5 cm in diameter , belonging to the infiltrative type , with serosal involvement and（or） N3 positive（P 〈 0.05）. The incidence of complications occurring in our cases was not noticeably increased and there was no operative mortality . Conclusion： Para - aortic lymph node metastasis do occur in some of the advanced gastric cancer patients . Selective para - aortic lymph node dissection procedure appears to be relatively safe and feasible. The impact of para - aortic lymph node dissection procedure on the long- term prognosis of AGG remains to be clarified by further studies.