摘要
目的 探讨胃癌淋巴转移规律和胃癌根治术的淋巴清扫范围。 方法 1990年～ 1999年行D2 、D3、D3 淋巴结廓清术加腹主动脉旁淋巴结廓清术 (D3 加PAL)的胃癌患者 32 6例 ,对其临床资料进行回顾性分析。 结果 本组总的淋巴结转移率 6 9 9% ,早期与进展期胃癌淋巴结转移率分别为 15 4%和 77 4%。肿瘤浸润深度达T1的患者 ,淋巴结转移主要局限于N1;达T2 的患者淋巴结转移至N3、M1的 8 1% ;达T3、T4 的患者转移至N3、M1的 2 8 7%。行D3 加PAL廓清术的患者 10 7例 ,16a2 ,b1组淋巴结转移率 15 0 % ,其均为进展期胃癌患者 ,均有N1～N2 淋巴结转移 ,癌灶≥ 5cm ,肿瘤浸润深度达T3、T4 。弥漫型胃癌患者 16a2 ,b1组淋巴结转移率高达 38 5 %。行D3 加PAL廓清术的患者 ,术后 3年、5年生存率分别为 6 0 7%、5 0 0 % ;其中有 16a2 ,b1组淋巴结转移的患者 1年、2年生存率分别为 6 0 0 %、5 0 0 %。 结论 对早期胃癌建议选择D2 廓清术 ,对相对较早的进展期胃癌应行D3 廓清术 ,对高度怀疑或证实有N1～N2 淋巴结转移、癌灶≥ 5cm、肿瘤已浸润浆膜等情况的进展期胃癌 ,应尽可能行D3
Objective To investigate the pattern of lymph node metastasis and the extent of lymph node dissection for gastric cancer. ]Methods 326 patients with gastric cancer admitted from 1990 to 1999 were analyzed retrospectively after D 2, D 3 or D 3 plus para aortic lymphadenectomy (D 3+PAL). Results The total incidence of lymph node metastasis was 69 9%; node involvement was 15 4% and 77 4% respectively for early gastric cancer and advanced gastric cancer. Depth of invasion, tumor size and histology affected lymph node metastasis significantly ( P <0 05). For T 1 patients, node involvement was mainly confined to N 1 and one patient had N 2 metastasis; 8 1% of T 2 patients and 28 7% of T 3, T 4 patients had N 3, M 1 lymph node metastasis. Among 107 patients who received D 3+PAL, 16a2b1 lymph node metastasis was found in 15 0%. The patients who had 16a2b1 node involvement were all suffered from advanced gastric cancer and N 1 N 2 node metastasis. In the patients with serosal invasion positive tumors or tumors size over 5 cm, the incidence of 16a2b1 metastasis was high, and that of entire stomach cancer was up to 38 5%. The 3 year and 5 year survival rates for D 3+PAL group were 60 7% and 50 0% respectively. After D 3+PAL, the 1 and 2 year survival rate,of patients with 16a2b1 metastasis were 60 0%, 50 0% respectively. Conclusions D 2 lymphadenectomy should be taken for patients with early gastric cancer and D 3 lymphadenectomy for those with relatively early' advanced gastric cancer. For advanced gastric cancer with suspect or confirmed N 1 N 2 node metastasis, tumor size over 5 cm and/or serosa invasion, D 3 plus para aortic lymphadenectomy appears to be a necessary surgical procedure.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2000年第10期752-755,共4页
Chinese Journal of Surgery
关键词
胃肿瘤
淋巴结切除术
淋巴结转移
清扫范围
Stomach neoplasms
Neoplasm metastasis
Aorta, abdominal
Lymph nodes
Lymph node excision
