进展期远端胃癌D_2根治术No.12b组淋巴结清扫60例分析

Analysis of No.12b Lymph Node Dissection for 60 Cases of Advanced Distal Gastric Cancer Accepting D_2 Lymphadenectomy

目的探讨进展期远端胃癌行D2根治术时No.12b组淋巴结清扫的必要性及可行性,及No.12b组淋巴结转移与临床病理因素的关系。方法回顾性收集60例进展期远端胃癌患者的病例资料,患者行D2或D2+根治术,并均加行No.12b组淋巴结清扫术。分析No.12b组淋巴结转移与临床病理因素的关系。结果全组无手术死亡病例,无严重并发症发生。60例患者中发现12例有No.12b组淋巴结转移,转移率为20.00%。其中BorrmannⅢ、Ⅳ型者No.12b组淋巴结转移率为31.25%(10/32),淋巴结转移N2～3期者为30.30%(10/33),肿瘤浸润T3～4期者为29.73%(11/37),明显高于BorrmannⅠ、Ⅱ型〔7.14%(2/28)〕,N0～1期〔7.41%(2/27)〕及T1～2期者〔4.35%(1/23)〕,P<0.05;No.12b组淋巴结转移与肿瘤的大小无关(P>0.05)。结论 No.12b组淋巴结清扫术对于进展期胃远端癌是必要且可行的,其远期效果有待大样本的前瞻性研究进一步证实。

Objective To study the necessity and feasibility of No.12b lymph node dissection in D2 lymphadenectomy for advanced distal gastric cancer,and the relation between No.12b lymph node metastasis and clinicopathologic factors.Methods Clinical data of sixty cases of advanced distal gastric cancer receiving D2 or D2＋ radical correction were collected retrospectively,both of which were all plus No.12b lymph node dissections.The relationships between No.12b lymph node metastasis and clinicopathologic factors were analyzed.Results No death attributed to operation or severe operative complications were found.There were 12 cases（20.00%） with No.12b lymph node metastasis.The rates of No.12b lymph node metastasis in Borrmann Ⅲ-Ⅳ types,N2-3 of lymph node metastasis and T3-4 of tumor infiltration were 31.25%（10/32）,30.30%（10/33） and 29.73%（11/37）,which were significantly higher than those in Borrmann Ⅰ-Ⅱ types（7.14%（2/28））,N0-1（7.41%（2/27）） and T1-2（4.35%（1/23）） respectively（P〈0.05）.There was no relationship between tumor size and No.12b lymph node metastasis.Conclusions No.12b lymph node dissection is safe and feasible for advanced distal gastric cancer.Further perspective studies on No.12b lymph node dissection influence on prognosis in more cases are required.