进展期胃癌腹主动脉旁淋巴结廓清术的临床研究

Clinical study on the dissection of lmyph nodes around abdominal aortic artery in advanced gastric cancer

目的 研究进展期胃癌 (AGC)腹主动脉旁淋巴结 (16LN)转移情况和D4式手术的适应证。方法 AGC 5 3例 ,随机分为D2 廓清术组 (n =32 )及D4廓清术组 (n =2 1) ;分析16组淋巴结转移与临床病理的关系 ,比较D4和D2 式廓清术手术创伤程度、手术并发症与死亡率 ,术后生活质量 (QOL)以及患者的预后。结果 2 1例行D4式廓清术者的 16LN转移率为 2 8 6 %。与胃癌侵犯或穿透浆膜深度及N2 转移与Ⅲ Ⅳa期胃癌有密切相关性 (P <0 .0 5 )。与D2 组比较 ,D4廓清术导致手术创伤程度增加 ,但手术并发症率、死亡率及平均住院天数无明显增加 ,术后QOL无明显差异。结论 D4廓清术对AGC是安全、合理和可行的。其适应证为 :①癌肿侵及浆膜层 ;②Ⅲ ,Ⅳa期胃癌 ;③N2 淋巴结阳性者 ;④

Objective To study the metastasis of para aortic artery lymph nodes(16LN) in advanced gastric cancer(AGC), and the indications of gastrectomy with radical dissection of lymph nodes around aortic artery(D 4 lymph node clearance, D 4 LC). Methods 53 AGC cases were divided randomly into two groups: D 4LC group(n=21) and D 2LC(n=32). The relationship between the 16LN metastasis and the clinico pathological features was analysed. The operative invasive degree, operative morbidity and mortality, quality of life and survival rate after operation were compared in these two groups. Results The 16LN metastasis rate in D 4LN group was 28.6%, significantly increased with the tumor invading to or through the serum member, N 2 metastasis and Ⅲ Ⅳa stages respectively(P<0.05). In comparison with D 2LC, D 4LC would increase the operative injury extent, but the operative morbidity, mortality and the hospital stay days did not increase significantly, and the quality of life after operation in these two groups did not show significant difference. Conclusions This study suggests that the D 4LC for AGC is safe, reasonable andfeasible. The indications of D 4LC are as follows: (1) the tumor invading to or thorough the serum member; (2) AGC in Ⅲ,Ⅳa stages; (3) N 2 metastasis; (4) 16LN metastasis.