早期胃癌非治愈性切除患者腹部增强CT检测淋巴结转移指导超级微创手术治疗合理性临床结果分析

Clinical analytical results of enhanced abdominal CT detection of lymph node metastasis in patients with non-curable resection of early gastric cancer to guide the rational treatment of super minimally invasive surgery

目的探讨早期胃癌非治愈性切除患者行腹部增强CT检测腹部淋巴结转移的合理性。方法回顾性分析2009年7月至2023年7月就诊于解放军总医院第一医学中心的早期胃癌非治愈性切除患者的一般资料、术前或术后腹部增强CT结果、早期胃癌非治愈性切除病理标本信息以及追加外科手术相关信息。结果接受超级微创治疗患者中术后考虑非治愈性切除胃癌共73例,其中,eCuraA 4例,eCuraB 5例,eCuraC14例,eCuraC260例。病理类型中,高分化管状腺癌43例,低分化管状腺癌10例,黏液/印戒细胞癌16例,高级上皮内瘤变4例。术后标本评估方面,切缘阳性共30例,水平切缘阳性9例,垂直切缘阳性23例,8例存在脉管和血管的侵犯。73例患者中,67例腹部增强CT提示淋巴结未见异常,6例提示淋巴结异常。其中,67例腹部增强CT未见异常患者追加外科手术后病理标本提示2例存在淋巴结转移;6例腹部增强CT提示淋巴结异常患者追加外科手术后淋巴结均未见转移。结论对于早期胃癌患者行腹部增强CT检测淋巴结转移是可行的,但是实际存在淋巴结转移的患者比例较低,这一方面仍需进一步的大样本多中心研究予以证实。

Objective To investigate the rationality of abdominal enhanced CT to detect lymph node metastasis in patients with early gastric cancer after non-curable resection.Methods Retrospective analysis was done on the general information of patients with non-curable early gastric cancer who were admitted to the First Medical Center of the PLA General Hospital from July 2009 to July 2023,as well as on the enhanced abdominal CT results obtained either before or after surgery,the information about the pathological specimen of the non-curable early gastric cancer,and additional surgical data.Results With a mean age of 61(53-67)years,73 patients were evaluated for postoperative non-curable resection of gastric cancer;58 patients were male and 15 patients were female.Of the 73 patients,4 patients had eCuraA,5 patients had eCuraB,4 patients had eCuraC1,and 60 patients had eCuraC2.In terms of pathological types,there were 43 patients of highly differentiated tubular adenocarcinoma,10 patients of poorly differentiated tubular adenocarcinoma,16 patients of mucous/ring cell carcinoma,and 4 patients of high-grade intraepithelial neoplasia.A total of 30 patients were positive on postoperative incisional margins,9 patients were positive on horizontal incisional margins,and 23 patients were positive on vertical incisional margins.It should be noted that 2 patients of them were positive on both horizontal and vertical margins.Among the 73 patients,67 patients had no abnormal lymph nodes indicated by enhanced abdominal CT,6 patients had abnormal lymph nodes indicated by enhanced abdominal CT,and 2 patients had lymph node metastasis indicated by postoperative pathological specimens of 67 patients had no abnormal lymph nodes indicated by additional surgery.No lymph node metastasis was found in 6 patients with abnormal lymph nodes after additional surgery.Conclusions Enhanced abdominal CT detection of lymph node metastasis is feasible for patients with early gastric cancer,but the proportion of patients with lymph node metastasis is relatively low,which still needs to be confirmed by further large-sample multi-center studies.