胃癌根治术中切除胰腺被膜及横结肠系膜前叶的临床意义

Resection of pancreatic capsule and anterior layer of transverse mesocolon in radical gastrectomy and its clinical significance

目的探讨胃癌根治术胰腺被膜及横结肠系膜前叶切除的临床意义。方法将2007年1月至2008年7月间拟行手术的213例胃癌患者随机分为两组：R组（105例）在手术中切除胰腺被膜及横结肠系膜前叶：N组（108例）不切除胰腺被膜及横结肠系膜前叶。对手术切除标本进行病理组织学检查．判断胰腺被膜及横结肠系膜前叶是否存在癌转移：同时分析胰腺被膜及横结肠系膜前叶癌转移与患者性别、年龄、肿瘤部位、大小、Bomnann分型、浸润深度、临床分期、病理分级和淋巴结转移程度等方面的关系；并对两组不同手术方法的手术时间、术中出血量、清扫淋巴结总数、术后并发症进行比较。结果两组不同手术方法组间在术中出血量、术后并发症发生率等指标之间差异无统计学意义（P〉0．05）；但R组较N组手术时间长（P〈0．05），清扫淋巴结总数多（P〈0．01）。R组胰腺被膜及（或）横结肠系膜前叶存在癌转移9例（8．6％）。胃癌胰腺被膜及横结肠系膜前叶癌转移与患者肿瘤浸润深度、前后壁位置、临床分期、淋巴结转移程度有关（P＜0．05），而与患者年龄、性别和肿瘤部位、大小、Borrmann分型及病理分级无关（P〉0．05）。结论胃癌根治手术应合理切除胰腺被膜及横结肠系膜前叶。

Objective To investigate the clinical significance of resection of the pancreatic capsule and anterior layer of transverse mesocolon in radical gastrectomy. Methods Between January 2007 and July 2008, a total of 213 gastric cancer patients enrolled in the study. These patients were randomly assigned into two groups： 105 in group R and 108 in group N. Only in group R were the pancreatic capsule and anterior layer of transverse mesocolon resected during radical gastrectomy. The pancreatic capsule and anterior layer of transverse mesocolon were histologically analyzed for metastasis. The data including blood loss during operations, number of dissected lymph nodes and postoperative complications were analyzed in both groups. Results There were no significant differences between the two groups in blood loss during operation and postoperative complications, but the differences in operation time and number of dissected lymph nodes between the two groups were significant. Metastases to the pancreatic capsule and/or anterior layer of transverse mesocolon were diagnosed in nine （8.6%） patients of group R. The metastases to the pancreatic capsule and/or anterior layer of transverse mesocolon were found to be associated with tumor invasion depth, anterior or posterior gastric wall, clinical staging and perigastric lymph node metastasis extent（P〈0.05）, but not with age, gender, tumor location, size, Borrmann type and pathological classification （P〉0.05）. Conclusions Resection of pancreatic capsule and anterior layer of transverse mesocolon in group R does not increase postoperative complications in comparison with group N. The resection is beneficial to the patients with advanced gastric cancer staging relatively late because of potential metastasis to pancreatic capsule and anterior layer of transverse mesocolon.