35例进展期胃癌根治术第Ⅱ、Ⅲ站淋巴结清扫的临床应用

Cleanup of Lymph Nodes in Ⅱ、Ⅲ Stations for Eradicating Advancing Gastric Cancer (Report of 35 Cases)

目的:通过对35例进展期胃癌(AGC)行胃癌根治术第Ⅱ、Ⅲ站淋巴结清扫(R_2、R_3式手术)探讨AGC淋巴结转移的规律,阐明对AGC行R_2、R_3式手术的临床合理性及进行第Ⅱ、Ⅲ站淋巴结清扫的必要性。方法:采用硬脊膜外麻醉或全麻,取上腹正中并绕脐下2～3cm切口,按规范的AGC R_2、R_3式手术操作进行。结果:35例均施行R_2、R_3式手术,手术时间平均5h左右,术后病理证实中分化腺癌20例,低分化腺癌9例,粘液腺癌6例,均有浆肌层浸润,其中淋巴结转移n_1(+)35例,n_2(+)26例,n_3(+)3例。术后病人均恢复顺利,其中2例全胃切除合并脾脏切除。本组病人术后经B超、消化道钡透或CT复查,以及定期随访5年10例,无瘤存活4例,癌灶复发转移死亡6例;随访3年10例,均无瘤健在;随访1年9例,均未见复发和转移灶,健康生存。结论:AGC行R_2、R_3式手术能达到一定的手术彻底性,明显提高患者的生存率。此术式有一定的可行性,值得临床应用。

Objective:To study the regularity of advancing gastric cancer (AGC) lymph nodes metastasis,explain the clinical rationalization of undertaking R2 and R3 operations for removing AGC and the necessity of cleanup of lymph nodes in Ⅱ and Ⅲ stations. Methods:35 cases were undergone R2 and Rj operations. It was documented pathologically that there were 20 cases with middle-differentiated adenoma,9 with poor-differentiated adenoma,6 with mucus adenoma. Among them there were 35 cases with lymph node metastasis n1 ( + ), 26 cases with n2( + ), 3 with 113 ( + ). After operation the patients got well. 10 patients were followed-up for 5 years. The results show that 3 cases were survival without cancers and 6 died of cancer metastasis. Another 10 patients followed-up for 3 years were all well without cancers.9 cases followed-up for one year all existed well. Conclusion: R2 and R3 operations may cure AGC in some degree and increase markedly the survival rate. This kind of operation is feasible in clinic.