低分化型黏膜内胃癌淋巴结转移的危险因素与腹腔镜手术探讨

Risk factors for lymph node metastasis in intramucosal poorly differentiated gastric cancer and reasonable laparoscopic surgery

目的:探讨低分化型黏膜内胃癌淋巴结转移的危险因素,从而对低分化型黏膜内胃癌患者,制定合理腹腔镜术式提供理论依据。方法:回顾性分析60例低分化型黏膜内胃癌的临床病理资料,按照临床病理特征与淋巴结转移的关系进行统计学分析。结果:通过多因素分析,多发肿瘤,肿瘤大小≥2 cm和淋巴管癌栓阳性对淋巴结转移差异具有统计学意义(P<0.05)。无危险因素的患者,淋巴结转移率为0;三个危险因素均有者,淋巴结转移率高达66.7%。结论:多发肿瘤,肿瘤大小≥2 cm和淋巴管癌栓阳性是低分化型分化型黏膜内胃癌淋巴结转移的独立危险因素。对于无危险因素的患者,行腹腔镜下胃局部切除术是可行的;对于具有危险因素的患者,可以实施腹腔镜下胃癌根治术治疗。

Objective： This study aimed to investigate the clinicopathological factors predictive of lymph node metastasis （LNM） in intramucosal poorly differentiated early gastric cancer （EGC）, and to expand the possibility of laparoscopic surgery for treating poorly differentiated EGC. Methods： Data of 60 patients with intramucosal poorly differentiated EGC and surgically treated in our hospital were collected. The association between the LNM and clinicopathological factors was retrospectively analyzed using univariate and multivariate logistic regression analyses. Results： Univariate analysis showed that the tumor size, number of tumors, and lymphatic vessel involvement （LVI） were the significant and independent risk factors for LNM. The LNM rate was 66.7% in patients with the three risk factors. LNM was not found in patients without the three clinicopathological risk factors. Conclusion： The tumor size, number of the tumors, and LVI were independently associated with the presence of LNM in intramucosal poorly differentiated EGC. Laparoscopic wedge resection can be sufficient to treat natients without the risk factors. Gastrectomy with lymphadenectomy is inevitable for patients with the risk factors.