根治性淋巴结清扫联合脾切除在残胃癌手术中的临床意义探究

The clinical significance of radical lymphadenectomy with splenectomy in remnant gastric cancer

目的阐明淋巴结清扫与脾切除在残胃癌手术中的重要性。方法远端残胃癌患者63例,行D_2行淋巴结切除23例,非D_2淋巴结切除40例,并行脾切除30例,未行脾切除33例。观察患者的术后总体生存率,分析残胃癌患者全胃切除术后临床病理特征、手术治疗和长期预后。结果D_2淋巴结清扫术和非D_2淋巴结清扫术切除淋巴结的平均数量分别为(16.5±1.5)枚和(7.7±1.4)枚,两者比较差异有统计学意义(P<0.01);pT1/pT2肿瘤患者脾门区域无淋巴结转移,pT3/pT4肿瘤患者发生淋巴结转移4例;浸润深度为pT3/pT4肿瘤患者切脾组生存率高于保脾组(P<0.01),而pT1/pT2肿瘤患者差异无统计学意义(P>0.05);浸润深度为pT3/pT4肿瘤患者D_2淋巴清扫术组生存率高于非D_2组(P<0.01),而pT1/pT2肿瘤患者则无明显差异(P>0.05)。结论根治性淋巴结清扫与脾切除对晚期(pT3/pT4)残胃癌患者有益。

Objective To clarify the significance of lymphadenectomy with splenectomy in rem-nant gastric cancer surgery. Methods This retrospective cohort study was conducted in 63 remnant gas-tric cancer patients,23 cases were treated by D2 lymphadenectomy,40 cases were treated by D2 lymphade-nectomy,30 cases were treated with splenectomy,other 33 cases were no such treated. The clinicopatholog-ic features,surgical treatments,and long-term prognosis were analyzed in remnant gastric cancer patients treated with total gastrectomy. Results The mean number of dissected lymph nodes for D2 lymphadenec-tomy and non-D2 lymphadenectomy were 16. 5 ± 1. 5 and 7. 7 ± 1. 4,respectively（P 〈 0. 01）. Lymph node metastasis at the splenic hilum was not observed in the patients with pT1 / pT2 tumors,although nodal me-tastases at the splenic hilum were detected in 4 patients with pT3 / pT4 tumors. The survival rate of patients with pT3 / pT4 tumors who underwent splenectomy was significantly higher than that of non-splenectomized patients（P 〈 0. 01）,although no difference was observed in the patients with pT1 / pT2 tumors（ P 〉0. 05）. The survival rate of the patients with pT3 / pT4 tumors who underwent D2 lymphadenectomy was significantly higher than that of the patients who underwent lymphadenectomy without D2 dissection（P 〈0. 01）,although no difference was observed in the patients with pT1 / pT2 tumors（P 〉 0. 05）. Conclusion Lymphadenectomy with splenectomy in radical surgery is beneficial for patients with advanced（ pT3/ pT4）remnant gastric cancer.