胃下部癌No．14v淋巴结转移及微转移研究

Study on metastasis and micrometastasisi in No.14v lymph nodes of patients with lower third gastric cancer

目的探讨胃下部癌No．14v淋巴结转移及微转移情况。方法回顾性分析青岛大学医学院附属医院普通外科2007年9月至2008年9月期间由同一术者连续施行根治性手术的53例胃下部癌患者的临床资料．并采用常规病理检查和端粒酶活性检测法分别检测手术清扫的No.14v淋巴结转移转移和微转移情况。结果本组53例胃下部癌患者术中共获取No．14v淋巴结96枚，每例1-3（平均1．8）枚。常规病理检查提示有9例患者（11枚）No．14v淋巴结发生转移，淋巴结转移率为17．0％。常规病理检查阴性的44例患者中有13例（13枚）No．14v淋巴结出现微转移．淋巴结微转移率为29．5％（13／44）。总的淋巴结转移率（转移加微转移）为41．5％（22／53）。No.14。淋巴结转移和微转移与本组胃癌患者Bomnann分型、No．6淋巴结转移、肿瘤大小、浸润深度及肿瘤TNM分期有关（P〈0．05），而与年龄、性别、肿瘤分化程度无关（P〉0．05）。结论胃下部癌患者No．14，淋巴结存在较高的转移率及微转移率：No．6淋巴结状态可以为术中判断No．14v淋巴结转移与否提供参考。

Objective To study the metastasis and micrometastasis in No.14v lymph nodes in patients with lower third gastric cancer. Methods A retrospective study was performed. A total of 53 patients undergoing radical resections by a single surgeon for lower third gastric cancer in the Department of General Surgery at the Affiliated Hospital of Qingdao Medical College were included. Conventional pathological section was used to detect lymph nodes metastasis and telomere TRAP-ELISA was used to identify the micrometastasis in No. 14v lymph nodes. Results A total of 96 lymph nodes were dissected from the No.14v group and lymph nodes metastasis were discovered in 9 patients by conventional pathological section. Forty-four patients had no metastasis on conventional pathological examination, of whom 13 （29.6%） were found to have micrometastasis. The overall metastatic rate was 41.5% （22/53）. Metastasis and micrometastasis in the No.14v lymph nodes were associated with Bornnann types, depth of invasion, No.6 lymph nodes metastasis, tumor diameter, and TNM staging. （P〈0.05）. Conclusions No.14v lymph nodes in patients with lower third gastric cancer is associated with a high incidence of metastasis and micrometastasis. The status of No.6 lymph nodes may be used as an useful indicator for No. 14v lymph nodes metastases during the operation.