进展期中上部胃癌脾门淋巴结转移与微转移的分析

Study on metastasis and micrometastasis in splenic lymph nodes of patients with middle third of gastric cancer

目的分析进展期中上部胃癌脾门淋巴结转移与微转移情况。方法回顾性分析2011年8月至2014年8月82例接受全胃切除D2根治术的进展期中上部胃癌患者临床病理资料,运用免疫组化检测淋巴结微转移,分析脾门淋巴结转移和微转移的临床病理高危因素。结果 82例患者共检及150枚脾门淋巴结,其中18例发生转移(21.9%),常规病理学检测阴性的64例患者中有21例出现微转移(32.8%)。单因素及多因素分析均显示TNM分期、Borrmann分型、肿瘤横向部位是脾门淋巴结转移的高危因素,而T分期、肿瘤横向部位是微转移的独立危险因素。结论中上部进展期胃癌脾门淋巴结转移及微转移发生率较高,Borrmann分型、TNM分期、肿瘤横向部位、T分期是脾门淋巴结总体转移的高危因素,含有以上临床病理特征者建议常规行脾门淋巴结清扫。

Objective To study metastasis and micrometastasis of splenic lymph nodes in patients with middle third of gastric cancer.Methods A retrospective study was performed. A total of 82 patients undergoing total gastrectomy D2 resection for middle third gastric cancer in this hospital were included. Immunohistochemical stain was used to detect lymph node micrometastasis,then clinical and pathological risk factors of splenic lymph nodes metastasis and micrometastasis were analysed. Results A total of 150 lymph nodes were dissected from the splenic lymph nodes and lymph nodes metastasis were discovered in 18( 21. 9%) patients by conventional pathological section. Sixty-four patients had no metastasis on conventional pathological examination,of whom 21( 32. 8%) were found to have micrometastasis. The univariate and multivariate analysis showed TNM stage,Borrmann type,Tumor transverse location were associated with splenic lymph node metastasis. T stage and tumor transverse location were independent risk factors for micrometastasis. Conclusion Splenic lymph nodes in patients with middle third gastric cancer is associated with a high incidence of metastasis and micrometastasis. Borrmann type,TNM stage,tumor lateral location,T stage are risk factors for splenic lymph node metastasis and micrometastasis,and patients with the above factors are recommended dissection for routinely splenic lymph node.