进展期胃癌病人门静脉周围淋巴结(No12pLN)清扫研究

Periportal Lymph Nodes(No12p LN) Dissection in Patients with Advanced Gastric Cancer

目的分析并评价进展期胃癌门静脉周围淋巴结(No12p LN)清扫术的可行性以及No12p LN转移与临床病理因素的相关性。方法将我院收治的53例进展期胃癌患者分成两组,其中观察组31例病人实施D2根治术联合门静脉周围淋巴结(No12p LN)清扫术;对照组22例病人仅实施D2根治术。结果观察组未见手术死亡病例,亦未见胆瘘、吻合口瘘、大出血以及术后阻塞性黄疸病例;对照组未见手术死亡病例,术后出现严重腹泻、胃瘫、腹腔感染各1例。观察组与对照组术后住院时间以及术中出血量方面比较无显著差异(P>0.05);观察组的手术时间明显长于对照组,差异显著,具有统计学意义(P<0.05)。观察组31例病人共清扫出551个淋巴结,平均每位病人清扫出17.8个淋巴结,其中出现转移的淋巴结共111个。No12p淋巴结转移和No5淋巴结转移具有相关性。No12p LN转移率在BormannⅢ和Ⅳ型、T3-4、N2-3期以及肿块大于>4 cm病人中明显大于BormannⅠ和Ⅱ型、T1-2、N0-1期以及肿块<4 cm的病人,差异显著(P<0.05);组织分型显示No12p LN转移率较高者为黏液腺癌与低分化腺癌,但与其他组织分型相比并无统计学意义。结论 No12p淋巴结清扫术对12p组淋巴结转移率较高者是有积极意义的,但其远期疗效尚需大样本的深入研究以证实。

Objective To analyze and evaluate the feasibility of periportal lymph nodes （No l2p LN） dissection in advanced gastric cancer and relevance of Nol2p LN metastasis and clinical pathological factors. Methods Fifty-three cases of advanced gastric cancer patients in our hospital were divided into two groups： thirty-one patients of the observation group received D2 resection combined with periportal lymph nodes （No 12p LN） dissection; twenty-two patients of the control group only received D2 resection. Results No operative death, biliary fistula, anastomotic leakage, bleeding or postoperative obstructive jaundice was found in the observation group; no operative death was found in the control group, but i case of postoperative severe diarrhea, 1 case of stomach paralysis, and 1 case of abdominal infection occurred. Postoperative hospital stay and blood loss showed no significant difference between the two groups （P 〉0.05）. The operation time was significantly longer in the observation group than that in the control gorup （P 〈0.05）. Among the 31 patients in the observation group, 551 lymph nodes were dissected, 17.8 lymph node dissection per patient on average, a total of 111 lymph nodes were metastasized. Nol2p lymph node metastasis and No5 lymph node metastasis were relevant. Nol2p LN metastasis rate was higher in patients of Bormann III and IV type, T3-4, N2.3 stage, and with mass size 〉4 cm than that in patients of Bormann I and II type, T1-2, N0-1 stag, with mass size 〈4 cm; the difference was significant （P〈0.05）. Tissue typing showed patients with higher No12p LN metastasis rate had mucinous adenocarcinoma with poorly differentiated adenocarcinoma, but the comparison with other histological type had no statistical significance. Conclusions Nol2p lymph node dissection is positive for patients with high 12p lymph node metastasis rate, but the long-term effect still needs a large sample of in-depth study to be confirmed.