胃癌D _4根治术

Superextended lymphadenectomy(D_4) in the treatment of gastric adenocarcinoma

目的 探讨胃癌D4根治术的临床意义。方法 总结 1997年 10月至 2 0 0 3年 10月 5 2例胃癌D4根治术的经验 ,通过无瘤接触、杀瘤技术、手术技巧、淋巴结的阳性率、TNM分期及治疗预后等资料进行分析。结果 胃大部分切除术 4 8例 ,全胃切除 4例 ,全部治愈出院。共清除淋巴结 883个 ,其中淋巴结转移71 2 % ;37例有淋巴结转移及有 1例No .16转移。Ⅰb期占 2 8 9% ,Ⅱ期占 15 4 % ,Ⅲa期占 19 2 % ,Ⅲb期占 11 5 % ,Ⅳ期占 2 8 9%。其 1、2、3年的生存率分别为 84 6 %、71 2 %及 5 5 7%。结论 D4术式是一种安全、可行及有效的术式 ,可提高Ⅰ、Ⅱ、Ⅲa期的生存率 ,其不但能精确TNM分期 。

Objective To investigate the clinical meaning of D 4 radical treatment in gastric cancer.Methods We summarized 52 cases of gastric cancer under D 4 radical therapy from October 1997 to October 2003.Data of non tumor contact technic,technic of tumor suide,operation technic,positive rate of lymph node,TNM classification and treatment,prognosis were analyzed.Results Subtotal gastrectomy acounted for 48 cases and total gastrectomy,4 cases.All cured and discharged.883 lymph nodes were extirpated,lymphtic nodes metastases was 71.2%.Among them 37 cases were found with lymph nodes metastasis and one patient,with N 4 metastasesthere.Stage Ⅰb acounted for 28.9% and stage Ⅱ 15.4%,Ⅲa 19.2%,Ⅲb 11.5%,and stage Ⅳ 28.9%.The 1～,2～,3～ year survival rate were 84.6%,71.2% and 55.7% respectively.Conclusion D 4 lymphadenectomy for gastri cancer is a safe,reasonable and effective method for increasing the survival rate in Ⅰ,Ⅱ,Ⅲa stage patient.It not only helps in accurately classif TNM type,but also promotes exchanges of academic experiences.