早期胃癌的淋巴结廓清研究

Clinical study of lymph node dissection for early gastric cancer

目的探讨早期胃癌的淋巴结转移规律和外科治疗疗效。方法回顾性分析1994年1月至2008年1月行D2以上手术治疗的165例早期胃癌的临床病理学资料和长期随访结果。结果黏膜内癌的淋巴结转移率为3．8％，且仅限于第1站的淋巴结；黏膜下层癌淋巴结转移率为25．7％，N2、N3均见不同程度的转移。胃上部的早期癌的淋巴结转移主要在第1站，但胃下部早期癌N2、N3均有转移，分别为5．2％、0．9％；淋巴结转移部位N2（＋）为No．7、8、9，N3（＋）为No．12、14V、16。肿瘤大小与淋巴结转移也有密切关系，〈5cm的黏膜内癌，淋巴结转移主要局限于第1站，但黏膜下层癌时随着肿瘤增大，第2、3站均见转移。黏膜内癌的累积5年生存率为97．3％，黏膜下层癌为87．6％（P=0．019）。淋巴结廓清范围与累积5年生存率关系为：D2为93．8％，03为91．7％（P=0．677）。结论早期胃癌中的黏膜下层癌D2或D2＋程度的淋巴结廓清是必要的，但胃上部早期癌、〈2em的黏膜内癌是缩小手术的适应证。

Objective To explore the pattern of lymph node metastasis and to determine a rational approach of surgery for early gastric cancer （EGC）. Methods Between January 1994 and January 2008, 165 patients with EGC were given 1）2 or over dissection. Clinicopathologie data of this group was analyzed retrospectively. Results The lymph node metastasis rate was 3.8% in mucosa carcinoma （m-carclnoma）, and was limited in first-tier; it was 25.7% in submucosa carcinoma （sin-carcinoma） and metastasized to second-tier and third-tier. Lymph node metastasis rate of EGC in u-region was low and was only limited in first-tier. But, in L-region, second- and third-tier lymph node metastasis was found in 5.2% and 0. 9% of the patients, respectively. Second-tier lymph node metastasis was found in No. 7, 8, 9 and third-tier in No. 12, 14V, 16. The tumor size and lymph node metastasis was related closely, the lymph node metastasis only involved first-tier in m-carcinoma with a diameter 〈 5 cm, but the second-tier was involved in all smcarcinoma. Significant difference was found in survival depending on the grade of tumor invasion： the cumulative 5-year survival rate was 97. 3% in the m-carcinoma and was 87. 6% in the sin-carcinoma （P = 0. 019）. There was no significant difference in survival between the extents in lymph node dissection （ I）2 93.8% , D3 91.7% ） （P =0. 677）. Conclusions D2 and D2 ＋ lymph node dissection is necessary for smearly gastric cancer. A less radical approach could be applied to m-early gastric cancer in the u-region with a diameter 〈 2 cm.