NO.4sa、4sb组淋巴结阳性率与进展期胃上部癌行脾门淋巴结清扫的相关性

Correlation between lymph node positive rate in NO.4sa and NO.4sb groups and splenic hilar lymph node dissection for advanced upper gastric cancer

目的分析进展期胃上部癌NO.4sa、NO.4sb组淋巴结阳性率与脾门淋巴结阳性率关系来指导是否行脾门淋巴结清扫术。方法选取南充市中心医院2016年12月至2018年12月腹腔镜下进展期胃上部癌根治术的病人92例,所有病人术中均常规清扫NO.4sa、NO.4sb及脾门淋巴结。对比NO.4sa、NO.4sb阳性组及阴性组脾门淋巴结阳性检出率。结果NO.4sa、NO.4sb阳性组25例,其中脾门淋巴结阳性5例,占20.00%;NO.4sa、NO.4sb阴性组67例,脾门淋巴结阳性3例,占4.48%;两者比较差异有统计学意义(P<0.05)。结论NO.4sa、NO.4sb组淋巴结可视为脾门淋巴结的“前哨淋巴结”。术中冰冻或快速石蜡切片检查NO.4sa、NO.4sb阳性或NO.4sa、NO.4sb虽为阴性但脾门淋巴结有明显肿大者,则需行脾门淋巴结清扫术以降低术后复发、转移风险。

Objective To analyze the relationship between the positive rate of lymph nodes in NO.4sa and NO.4sb groups and the positive rate of splenic hilum lymph nodes in advanced gastric cancer patients to guide whether to perform splenic hilar lymphadenectomy.Methods A total of 92 patients undergoing laparoscopic radical gastrectomy for upper gastric cancer from December 2016 to December 2018 in Nanchong Central Hospital were selected.All patients underwent routine removal of NO.4sa,NO.4sb and splenic hilar lymph nodes.The positive detection rates of splenic hilar lymph nodes in the positive and negative groups of NO.4sa and NO.4sb were compared.Results There were 25 cases in the positive group of NO.4sa and NO.4sb,among which 5 cases had positive detection of splenic hilar lymph node,accounting for 20.0%;there were 67 cases in the negative group of NO.4sa and NO.4sb,among which 3 cases had positive detection of splenic hilar lymph node,accounting for 4.48%.The difference between the two groups was statistically significant(P<0.05).Conclusions The lymph nodes of NO.4sa and NO.4sb groups can be regarded as“sentinel lymph nodes”of splenic hilar lymph nodes.During the operation,if frozen or rapid paraffin sections show NO.4sa and NO.4sb positive or even if NO.4sa and NO.4sb are negative but the splenic hilar lymph nodes show obvious enlargement splenic hilar lymph node dissection is needed to reduce the risk of recurrence and metastasis.