胃癌临床病理特征与淋巴结转移关系研究

The relationship between the clinicopathological characteristics and the lymph node metastasis of gastric cancer.

目的 探讨胃癌临床病理特征与淋巴结转移的关系 ,为临床进行合理的淋巴结清扫范围提供依据。方法 统计 12 0 0例胃癌标本 ,术后常规解剖原发灶及各组淋巴结 ,并标记和计数 ,计算肿瘤部位、浸润深度、Bor rmann分型及分化程度与淋巴结转移率的关系。结果 胃癌的淋巴结转移率为 73 % ,转移度为 35 6 % ;C、M、A区及全胃癌淋巴结转移率为 6 0 3 %、5 5 4%、6 3 1%和 88 4% ;早期胃癌、浆膜内和浆膜外浸润的淋巴结转移率依此呈递增趋势 (P <0 0 5 ) ;BorrmannⅢ、Ⅳ型胃癌淋巴结转移率明显高于BorrmannⅠ、Ⅱ型 (P <0 0 5 ) ;分化差者明显高于分化好者 (P <0 0 5 )。结论 术中淋巴结清扫应按胃癌的临床病理分期、部位、大小、大体分型和分化程度作出判断 ,并结合不同分区淋巴结分组、分站转移特点 ,合理选择淋巴结清扫范围。

Objective To investigate the relationship between clinicopathological features and lymph node metastasis (LNM) in the gastric cancer and offer the basis for deciding appropriate extent of lymph node dissection.Methods A total of 1200 patients who underwent curative gastrectomy and lymph node dissection for gastric cancer were analyzed retrospectively.Results The total rate of LNM was 73%,with 35.6% of the resected lymph nodes involved.The LNM of C,M,A region and the whole stomach were 60.3%,55.4%,63.1% and 88.4%,respectively.The rate of the lymph node metastasis increased in the earlier stage of gastric cancer,middle and late stages (P<0.05),the rate of LNM of the infiltrative tumor (Borrmann Ⅲ、Ⅳ)(26.1%～41.5%) was higher than that of Borrmann Ⅰ、Ⅱ.The metastasis rate of the good differentiation was higher than the had differentiation(P<0.05).Conclusion The study suggests the appropriate extent of lymph node dissection should be done during the operation on the basis of clinicopathological stages,type of Borrmanns,tumor invasion,differentiation,site and maximum diameter of gastric cancer along with the state of lymph node metastasis in cancer of different region of the stomach.