远端胃癌行D2根治术中清除第12p组淋巴结的临床意义

Clinical Significance of No.12p Lymphadenectomy in D2 Radical Resection of Distal Gastric Cancer

目的探讨远端胃癌行D2根治术中清除第12p组(No. 12p)淋巴结的临床意义。方法回顾性分析行胃癌D2根治术(对照组,n=126)、胃癌D2根治术中清扫No. 12p组淋巴结的远端胃癌患者(观察组,n=180)临床资料及病理资料,对比2组手术效果,分析No. 12p组淋巴结转移与临床病理参数的关系。结果观察组手术时间、术中出血量长/高于对照组(P <0. 05);其他指标比较,无统计学差异(P> 0. 05)。观察组中共24例在清扫中发现No. 12p淋巴结转移,转移率为13. 33%(24/180);BorrmanⅢ~Ⅳ型患者No. 12p淋巴结转移率高于BorrmanⅠ~Ⅱ型,多发癌No. 12p淋巴结转移率高于胃角、胃窦区,浆膜受侵者No. 12p淋巴结转移率高于浆膜未受侵者,高、中分化者No. 12p淋巴结转移率低于低分化者,N0~1 No. 12p淋巴结转移率低于N2~3,肿瘤直径<3 cm、3~5 cm者No. 12p淋巴结转移率低于肿瘤直径> 5 cm者,差异均有统计学意义(P <0. 05);Logistic回归分析发现,Borrman分型Ⅲ~Ⅳ型、浆膜受侵、分化程度低、肿瘤直径> 5 cm为远端胃癌患者发生No. 12p淋巴结转移的危险因素(P <0. 05)。结论远端胃癌行D2根治术中清除No. 12p淋巴结,不会明显影响手术效果,尤其对于Borrman分型Ⅲ~Ⅳ型、浆膜受侵、分化程度低、肿瘤直径> 5 cm患者可能有积极意义。

Objective To investigate the clinical significance of No. 12 plymphadenectomy in D2 radical resection of distal gastric cancer. Methods Clinical data and pathological data of patients with distal gastric cancer who underwent D2 radical resection of gastric cancer( control group,n = 126) and patients undergoing No. 12 p lymphadenectomy in D2 radical resection of distal gastric cancer( observation group,n = 180) were retrospectively analyzed. The surgical effects were compared between the 2 groups,and the relationship between No. 12 plymph node metastases and clinical pathological parameters was analyzed. Results The surgical time and intraoperative blood loss of the observation group were longer/higher than those of the control group( P <0. 05). There were no significant differences in other indexes( P > 0. 05). In the observation group,there were 24 cases with No.12 p lymph node metastases during the dissection,and the metastasis rate was 13. 33%( 24/180). The rate of No. 12 p lymph node metastases was higher in patients with Borrman Ⅲ~Ⅳ type than in those with Borrman Ⅰ~Ⅱ type,higher in multiple cancer than gastric angle or gastric antrum,and higher in patients with serous membrane invasion than in those without. The rate of No.12 p lymph node metastases was lower in patients with high and moderate differentiation than in those with poor differentiation,lower in N0 ~ 1 stage than in N2 ~ 3 stage,and lower in patients with tumor diameter < 3 cm or 3 ~ 5 cm than in patients with tumor diameter > 5 cm( P < 0. 05). Logistic regression analysis found that Borrman type Ⅲ~Ⅳ,serous membrane invasion,differentiation degree and tumor diameter > 5 cm were risk factors of No. 12 p lymph node metastases in patients with distal gastric cancer( P < 0. 05). Conclusion The No. 12 p lymphadenectomy in D2 radical resection of distal gastric cancer will not significantly affect the surgical outcome. It is good for patients with Borrman type Ⅲ~Ⅳ,serous membrane invasion,poor differentiation and tumor diameter > 5 cm.