胃上部癌淋巴结转移规律及其在外科治疗中的应用

Lymph node metastasis of upper gastric cancer and its significance in surgical treatment.

目的 研究胃上部癌腹腔淋巴结转移规律及其在外科治疗中的意义。方法 回顾性调查施行根治手术并具有完整临床病理资料的胃上部癌病例 ,分析各组、站淋巴结转移的频度及其与胃癌浸润深度的关系 ,并比较不同淋巴结分级的术后 5年生存率。结果 pT2 淋巴结转移阳性病例占 81% ,其中N1为 4 4 %、N2 为 37% ;pT3淋巴结转移占 83% ,N1为 30 %、N2 为 4 0 %、N3 为 13% ;而pT4则 10 0 %发生淋巴结转移。幽门上、下组 (N3 )转移率达 9%。不同转移淋巴结分级间术后 5年生存率差异有显著性。结论 进展期胃上部癌应行D2 以上的淋巴结清除术 。

Objective To determine the lymph node metastasis of upper gastric cancer and its significance in surgical treatment. Methods The frequency of lymph node metastases in each station or group was retrospectively studied in 107 patients with upper gastric cancer who underwent radical gastrectomy from January 1979 to December 1994 Results Positive lymph nodes occurred in 81%of pT 2 (44% N 1 and 37% N 2 ), 83%of pT 3 (30% N 1 ?40% N 2 and 13% N 3 ), and 100% of pT 4 Suprapyloric or infrapyloric station was involved in 9% upper gastric cancer cases. There was a highly significant difference in postoperative 5-year survival rates in different lymph node stages. Conclusion In the presence of advanced upper gastric cancer, the results of our study provide evidence for the need to perform a gastrectomy with at least D 2 lymphadenectomy.