进展期胃癌门静脉周围淋巴结(No12p LN)清扫

Periportal lymph node (No12p lymph node) clearance for patients with advanced gastric cancer

目的探讨进展期胃癌门静脉周围淋巴结(No12p LN)清扫的必要性、可行性及其与转移和临床病理因素的关系。方法将进展期胃癌病例51例分为2组,(1)研究组30例,行D2或选择性D3根治术,外加门静脉周围淋巴结(No12p LN)清扫。分析门静脉周围淋巴结(No12p LN)转移与临床病理因素的关系;(2)对照组,21例。行D2或选择性D3根治术,但均未行No12p LN(门静脉后淋巴结)清扫。比较研究组与对照组的平均手术时间,平均术中出血量。结果研究组30例患者共检查552个淋巴结,平均每例清扫18.4个淋巴结,发现有112个淋巴结发生转移,转移度为21.24%;30例中发现4例No12p LN转移,转移率为13.33%,其中BorrmannⅢ,Ⅳ型No12 LN转移率为16.67%,N2-3期为25%,T3-4者为16.67%,肿块大于4 cm者淋巴结转移率为33.33%;No12p淋巴结转移率在BorrmannⅢ,Ⅳ型,N2-3期,T3-4及肿块大于4 cm者中明显高于BorrmannⅠ,Ⅱ型(0%),N0-1期(0%),T1-2(0%),肿块小于4 cm(0%)(均P<0.05),且No12p淋巴结的转移与No5淋巴结转移之间存在相关性;胃体癌及肿块超过1/3胃区域的胃癌亦有较高No12p LN转移率;组织分型与No12pLN转移无明显关系。两组间除手术时间研究组长于对照组外(P<0.05),平均术后住院时间、平均术中出血量均无显著性差异(P>0.05);术后并发症分别为2例(6.67%),3例(14.29%)(P(0.05),均无严重并发症发生。两组均无死亡病例。结论 No12p LN清扫术对于部分进展期胃癌是可行且有一定临床意义的。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 periportal lymph node（No12p lymph node） clearance,and the relationship between No12p LN metastasis and clinicopathologic factors in advanced gastric cancer.Methods The clinical data of 51 patients with advanced gastric cancer were retrospective analyzed.The patients were divided into two groups： No12p LN clearance group and control group.In the clearance group,30 cases underwent D2 or selective D3 operation with additional No12p LN dissection.The relationship between No12p LN metastasis and clinicopathologic factors was analyzed.The 21 cases in the control group underwent D2 or selective D3 operation without No12p LN dissection.The operation time,bleeding volume,the incidence of postoperative complications and average hospital stay time after operation,between the two groups were compared.Results In clearance group,a total of 552 lymph nodes,with an average of 18.4 per case,were removed,and,of them,112 lymph nodes（21.24%） were found to be metastasis positive.Four of 30 patients（13.33%） had No12p LN metastasis.Metastasis rate of No12p LN was 16.67% in Borrmann types Ⅲ-Ⅳ,25% in N2-3,16.67% in T3-4,and 33.33% in cases of tumor mass 4 cm,respectively.The positive No12p LN metastasis rate found in patients with Borrmann types Ⅲ-Ⅳ,N2-3,T3-4 and with tumor mass 4 cm was significantly higher than that in Borrmann typesⅠ-Ⅱ（0%）,N0-1（0%）,T1-2（0%） and tumor mass 4 cm（0%）,respectively（P0.05）.The No12p LN metastasis was correlated with No5 lymph node metastasis,but had no evident correlation with histological type of cancer,or tumor located in body or occupied more than 1/3 area of the stomach.There were no significant differences between the two groups in operation bleeding volume and hospital stay time（P﹥0.05）,but the operation time of the No12p LN clearance group was longer than that of the control group（P0.05）.The incidence of postoperative complications was 2 cases（6.67%） in No12p LN clearance group and 3 cases（14.29%） in control group.No serious complications or death attributed to surgery were found in any of the groups.Conclusions No12p LN clearance is feasible for advanced gastric cancer.The long-term clinical effects of No12p LN clearance on advanced gastric cancer remain to be identified by prospective and large sample studies.