远端胃癌淋巴结转移规律及临床意义

Regularity of lymph node metastasis in distal gastric cancer and its clinical significance

目的:探讨远端胃癌各组淋巴结转移的特点,指导远端胃癌根治手术中淋巴结清扫的范围。方法:回顾性分析2010年2月至2014年9月天津医科大学肿瘤医院远端胃癌患者773例接受D2(D2+)胃次全切除术的临床病理资料,分析其淋巴结转移特点。结果:773例远端胃癌患者术后病理证实淋巴结转移为423例(54.72%),各组淋巴结中发生转移的患者所占比例由高至低依次为NO.6、NO.3、NO.4sb、NO.5组淋巴结。N1淋巴结转移率由高至低依次为NO.3、NO.6、NO.5、NO.4d组淋巴结;N2淋巴结转移率由高至低依次为NO.8a、NO.7、NO.1组淋巴结。50.68%的患者出现NO.8a组淋巴结跳跃性转移。结论:远端胃癌根治性手术应注意NO.8a淋巴结转移的可能性,必要时应适当扩大淋巴结的清扫范围。

Objective：The characteristics of lymph node metastasis were investigated to guide the range of lymph node dissection during the radical operation of distal gastric cancer. Methods：The clinical data of 773 patients with distal gastric cancer who under-went radical distal subtotal gastrectomy at the Tianjin Medical University Cancer Institute and Hospital between February 2010 and September 2014 were reviewed and analyzed to infer the potential clinical mechanisms of lymph node metastasis. Results：Among the included patients, 423 （54.72%） had lymph node metastasis. The proportion of metastasis in the patients from the highest to the lowest rate was observed in group NO. 6, 3, 4sb, and 5 lymph nodes. The metastasis rates of the N1 lymph nodes from the highest to the low-est were observed in group NO. 3, 6, 5, and 4d lymph nodes, whereas those of the N2 lymph nodes occurred in group NO. 8a, 7, and 1 lymph nodes. Group NO. 8a lymph node with skipped metastasis was observed in 50.68%of the patients. Conclusion：During radical distal gastric cancer surgery, attention should be given to the possibility of metastasis in group NO. 8a lymph node. Appropriate exten-sion of the lymph node dissection should be conducted when necessary.