早期胃癌缩小手术与扩大手术治疗结果的比较

Reduced vs Extended Gastrectomy in the Treatment of Early Gastric Cancer

目的：探讨早期胃癌缩小手术的适应证。方法：对１３８例早期胃癌的淋巴结转移特点及缩小手术与扩大手术治疗结果进行研究。结果：粘膜内癌淋巴结转移率为５１％，其中Ⅰ站为３９％，Ⅱ站为１３％；１ｃｍ以下癌灶无淋巴结转移，１５ｃｍ以上凹陷型早期胃癌开始出现淋巴结转移。粘膜下层癌淋巴结转移率为１８３％，其中Ⅰ站淋巴结转移率为１８３％，Ⅱ站为３３％，１ｃｍ大小的癌灶开始发现淋巴结转移。随访５年以上的１０９例中，３３例施行缩小手术（Ｄ１或Ｄ１＋Ｎ⑦），７６例行扩大手术（Ｄ２、Ｄ２＋ａ或Ｄ３），两组死于胃癌复发转移的分别为１３％、９％；其中死于淋巴结残胃转移复发的分别为６４％、４４％；死于淋巴结转移者原病灶均在３ｃｍ以上的凹陷型病灶中。结论：早期胃癌根治性缩小手术适合于粘膜内癌无溃疡的较小病灶病例，大部分仍需行Ｄ２或Ｄ２以上扩大手术。

Objective: To evaluate the justification of reduced gastrectomy in early gastric cancer Methods: Status of lymph node metastasis was scrutinized in 138 cases of early gastric cancer undergoing extensive or reduced gastrectomy was made Results: The rate of regional lymph node metastasis was 51%in cases with mucosal lesions (m type) including group I nodes in 39%and 13%in group nodes There was no lymph node involvement in lesions less than 1cm in diameter Patients with depressed lesions larger than 15cm in diameter were most likely to have lymph node metastasis In SM type early cancers nodal involvement was seen in 183%of cases including group I 15%and group II 33% The lymph node involvement was seen in cancers with 1cm in diameter One hundred and nine patients was followed up for more than 5 years, 33 cases of those treated with reduced gastrectomy (D1 or D1+N) and 76 cases treated with extensive resection (D2,D2+a or D3) In these two groups,deaths were accounted for by cancer recurrence and metas Gastrectomytasis in 13%and 9%respectively All of the patients who died of lymph node metastasis have had depressed lesions larger than 3cm in diameter Conclusion : It is suggested that reduced radical gastrectomy is indicated in mucosal cancers and minute lesions without ulceration D2 or D3 extensive resection is advisable in most of the patients