进展期近端胃癌淋巴结转移规律对手术范围的指导意义

The guide of the regularity of lymph node metastasis to the extent of resection for proximal advanced gastric cancer

目的分析进展期近端胃癌的淋巴结转移规律，为进展期近端胃癌的胃切除范围以及是否需要联合切脾提供临床病理学依据。方法选择1989年1月—2010年10月行根治性切除手术的进展期近端胃癌87例，记录每例患者的淋巴结数目和大小，计算淋巴结总数和平均值，计算总体淋巴结转移率以及No．1～16淋巴结转移率。结果87例手术标本共检出淋巴结4828枚（30—157枚），平均（55．49±20．19）枚／例。其中≤5mm的淋巴结占80．39％（3881／4828）。87例中71例有淋巴结转移。有癌转移的淋巴结中，≤5mm的淋巴结占61．22％（562／918）。总体淋巴结转移率为81．61％，No．1～4和No．7～9淋巴结转移率较高（40．22％-79．31％），而No．12～15淋巴结转移率极低（0—2．30％），No．16淋巴结转移率为14．94％；No．5和No．6淋巴结转移率分别为21．84％和14．94％，No．10和No．11淋巴结转移率分别为34．48％和19．54％。结论了解进展期近端胃癌的淋巴结转移规律有助于指导淋巴结切除术，因为切除No．5～6和No．10～11淋巴结的需要，进展期近端胃癌宜行全胃切除联合脾切除术。

Objective To investigate the regularity of lymph node metastasis in proximal advanced gastric cancer,in order to guide the extent of stomach resection （proximal or total gastreetomy） and the resection of spleen or splenic preservation. Methods The clinicopothological data of 87 patients with proximal advanced gastric cancer who underwent radical gastrectomy in our hospital from January 1989 to October 2010 were retro- spectively analyzed. The number and size of detected lymph nodes were recorded. The sum and the average num- ber of detected lymph nodes, the total rate of lymph node metastasis and the metastasis rates of No. 1-16 lymph nodes were calculated. Results A total of 4 828 （30 to 157 ） lymph nodes were detected form the surgical specimens of 87 patients with proximal advanced gastric cancer, and the average number of detected lymph nodes was 55.49 〉20.19. Among 4 828 lymph nodes, there were 3 881 nodes ≤5mm,accounting for 80.39%. 71 of 87 cases with lymph node metastasis, the total rate of lymph node metastasis was 81.61% ;Among 918 lymph nodes with metastasis, there were 562 nodes ≤5 mm, accounting for 61.22%. The metastasis rates of No. 1--4 and No. 7-9 lymph nodes were higher （40.22% to 79.31% ） ,the metastasis rates of No. 12-15 lymph nodes were lower（0 to 2.30% ） ,and the metastasis rate of No. 16 lymph node was 14.94%. The metastasis rates of No. 5 and No. 6 lymph nodes were 21.84% and 14.94%, respectively. The metastasis rates of No. 10 and No. 11 lymph nodes were 34.48% and 19.54% ,respectively. Conclusions The metastasis of lymph node in proximal advanced gastric cancer has certain regularity, which can provide a significant guidance for lymphadenectomy. Total gastrectomy plus splenectomy is a feasible radical surgery for proximal advanced gastric cancer, because of the requirement of lymphadenectomy for No. 5-6 and No. 10-11 lymph nodes.