进展期远端胃癌沿胆总管淋巴结(No.12b)清扫72例临床分析

Analysis of N0.12blymph node dissection for 72cases with advanced distal gastric carcinoma

目的探讨进展期远端胃癌No.12b组淋巴结(No.12bLN)清扫的必要性及可行性。方法收集胃远端癌72例,行D2根治术,外加No.12bLN的清扫;分析No.12bLN转移与临床病理因素的关系。结果 72例中,发现14例(19.44%)No.12bLN转移;其中BorrmannⅢ、Ⅳ型转移率为31.58%,N2-3期为30.77%,T3-4者为28.26%。BorrmannⅢ、Ⅳ型、N2-3期、T3-4病例的No.12bLN转移率明显高于BorrmannⅠ,Ⅱ型(7.14%),N0-1期(7.41%)、T1-2(4.35%)(P均<0.05),与肿瘤的大小无关。全组无严重并发症及手术死亡病例。结论对于进展期远端胃癌No.12bLN清扫术是必要、可行的,其远期效果有待进一步证实。

Objective To study the necessity and feasibility of No. 12b lymph node dissection for advanced distal gastric carcinoma. Method Seventy-two cases with advanced distal gastric carcinoma received D2 radical correction with the addition of No. 12b lymph node dissection. The relationship between No. 12b lymph node metastasis and clinicopathologic factors was analyized. Results Positive No. 12b lymph node was found in 14 of the 72 cases （19. 440/oo）, including 31.58% in Borrmann I]I or 1Vtypes, 30.77% in N2a, and 28.26% in Ta4. Positive rate of No. 12b node in patients with Borrmann Ⅲ or Ⅳ types, N2-3 and T34 was significantly higher than that in Borrmann Ⅰ or Ⅱ types （7.14%）, N01 （7.41%） and T1-2 （4.35%）, respective- ly （P^0.05）, and it had＇nothing to do with the size of the cancer mass. No death attributed to the operation. No severe operative complicatibns were found. Conclusion No. 12b lymph node dissection is feasible and necessary for advanced distal gastric carcinoma, and its long-term effect should be further confirmed.