淋巴结取材方法对胃癌淋巴结分期的影响

Effect of sampling method on lymph node staging of gastric carcinoma

目的：探讨淋巴结取材方法对胃癌淋巴结检查数目及分期的影响。方法36例接受根治性切除手术的进展期胃癌病例，根据淋巴结取材方法分为新鲜组（n ＝9）、固定组（n ＝9）和脱脂组（n ＝18）；记录每例患者的淋巴结数目，分别计算全组及亚组患者的淋巴结总数和平均值，比较亚组患者的淋巴结数目、转移淋巴结数目及 pN 分期。结果本组36例总体淋巴结转移率72％。新鲜组检出淋巴结（22．11±10．28）枚／例，固定组检出淋巴结（21．89±6．57）枚／例（t ＝0．052，P ＝0．960），故合并为传统组（n ＝18）；脱脂组检出淋巴结（55．83±16．77）枚／例（t ＝14．129， P ＜0．001）。传统组检出47枚（2～11枚／例）淋巴结转移，脱脂组检出223枚（2～77枚／例）淋巴结转移（t ＝2．295，P ＝0．035）。与传统组相比较，脱脂组 pN0-pN2病例明显减少，pN3a 和 pN3b 病例明显增加（χ2＝9．602，P ＝0．040）。结论脱脂法可以获取更多的淋巴结，淋巴结转移数目也随之增加，pN 分期上移。

Objective To investigate the effects of sampling method on number checking and staging of lymph node for gastric carcinoma.Methods A total of 36 advanced gastric carcinoma cases ac-cepted radical operation were selected and divided into the fresh group（n =9）,the fixed group（n =9）, and the degrease group（n =18）according to their sampling procedures.The lymph node number of each case was recorded.The total and mean lymph node numbers were calculated in total and subgroups.The numbers of lymph node and metastatic lymph node and pN staging were compared in subgroups.Results The lymph node metastasis ratio was 72% in 36 cases.The lymph nodes in the fresh groups and fixed groups were（22.11 ±10.28）pieces/case and（21.89 ±6.57）pieces/case（t =0.052,P =0.960）,and they were added as the traditional group.The lymph node in the degrease group was（55.83 ±16.77） pieces /case（t =14.129,P ＆lt;0.001）.A total of 47（range 2 ~11）metastatic lymph nodes in the traditional and 223（range 2 ~77）metastatic lymph nodes in the degrease group was found（t =2.295,P =0.035）. Compared with the traditional group,cases with pN0 to pN2 stages decreased and cases with pN3a and pN3b stages increased obviously in the skim group（χ2 =9.602,P =0.040）.Conclusion Degreasing can get more lymph nodes with increased metastatic nodes and pN stage.