胃癌的淋巴结转移规律及其意义

Study on the Rule of Lymph node Metastasis of Gastric Cancer

目的：探讨胃癌淋巴结转移规律及合理淋巴结清除术的原则和适应证。方法：采用病理组织学、免疫组织化学法研究转移淋巴结分型、分期、分级和计量学及淋巴结的检出率。结果：全组淋巴结转移率为74．8％，以No3、No7为高；不同病期的转移率有明显差别；转移淋巴结数量、级别和类型是反映胃癌生物学行为和预后的重要指标。胃癌组织中淋巴管癌栓（＋）、FDP、TPA高表达，E－cd低表达和DNA含量增高与淋巴结转移密切相关。术中胃壁内注射CH40，认识淋巴结跳跃性转移规律，切除标本美蓝染色结合淋巴结连续切片，对提高淋巴结清除率和检出率有一定的应用价值。结论：针对胃癌淋巴结清除率、分型、分期、分级和计量学，以及淋巴结转移率、检出率和分子标志物研究，对选择合理根治术式、提高生存率具有重要的临床意义。

Objective To explore the rule of lymph node (LN) metastasis of gastric cancer and the principle and indication of LN clearance． Methods Type.stage.grade and count of metastatic LNs as well as the detectable rate of LNs were studied by pathohistology and immunohistochemistry． Results The overall metastatic rate was 74．8％ with that of No3 and No7 the highest． There was apparent difference between the metastatic rates of different stages． The quantity.grade and type of metastatic LNs were considereed as the important indexes reflecting the biological behavior and prognosis of gastric cancer． LN metastasis was closely related to the positive cancerous emboli in lymphatic vessels.high expression of FDP and TPA.low expression of E－cd and increased DNA content in gastric cancer tissues． It was valuable for improving the clearance rate and detectable rate of LNs to inject CH40 into gastric wall during operation.to make clear the rule of jumping metastasis of LNs and to stain the resected specimen and serial section of LNs with Methylene blue． Conclusion The type.stage.grade and count of LNs.and studies on molecular markers are of important clinical significance for selecting rational modality of radical operation and improving survival rate．