摘要
近年来，胃癌的整体发病率在下降，但是进展期胃上部癌的发病率逐年上升，目前唯一有可能治愈进展期胃上部癌的方法是外科手术。手术的关键在于是否彻底清扫淋巴结。因为这直接影响着患者的术后生存率。淋巴结转移率是判断胃癌患者术后预后的重要指标之一．淋巴结转移率与肿瘤的浸润深度及肿瘤大小有关，尤其与肿瘤的浸润深度关系密切，通常肿瘤深度越深，肿瘤直径越大，淋巴结转移率相对越高。淋巴结转移率决定着进展期胃上部癌的淋巴结清扫范围，D：淋巴结清扫术能够更彻底地清扫胃周围转移淋巴结，可提高进展期胃癌患者术后生存率，已成为进展期胃癌的标准术式。但对于进展期胃上部癌，由于胃上部周围淋巴结转移途径复杂，其纵隔淋巴结、主动脉旁淋巴结、肠系膜上静脉周围淋巴结清扫的必要性，脾门淋巴结清扫时是否联合脾脏的切除以及当肿瘤直径〈4cm时胃远端淋巴结清扫的必要性都仍存争议。为尽量避免术后病理分期偏倚及指导术后进一步治疗，现在要求进展期胃上部癌淋巴结清扫数目不少于15枚，但具体清扫多少枚淋巴结可改善预后、提高生存时间也仍有争议。本文对进展期胃上部癌淋巴结清扫的的现状与研究进展予以综述，以期为胃上部癌淋巴结清扫的实施提供相关依据和参考。
In recent years, the incidence of gastric cancer has shown a decreasing trend. However, the incidence of advanced upper gastric cancer in China is steadily increasing. Nowadays, surgery is the only way to cure advanced gastric cancer, and lymph node dissection is the key of operation. Since lymph node metastasis is the main metastatic route of gastric cancer, it is critical for surgeons to be aware of this when performing lymph node dissection during operation. At present, the only possible cure for advanced gastric cancer is surgery. The key to a successful operation is to completely dissect the lymph nodes, which has a direct influence on the patient＇s postoperative survival rate. The lymph node metastasis rate is one of the important predictors of postoperative prognosis in patients with gastric cancer, which is related to the tumor size and especially the depth of invasion. Generally speaking, the deeper the tumor depth and/or the larger the tumor diameter, the relatively higher the lymph node metastasis rate will be. The lymph node metastasis rate determines the extent of lymph node dissection in advanced upper gastric cancer. As D2 lymphadenectomy can bring about a more thorough clearance for the perigastric metastatic lymph nodes and can improve the survival rate of patients with advanced gastric cancer, it has become the standard surgery for advanced gastric cancer. However, during treating advanced upper gastric cancer, since there are multiple and intricate ways for upper gastric cancer to metastasize through lymphatic route, there are still controversials on the necessity to perform mediastinal lymphadenectomy, para-aortic lymphadenectomy or dissection for lymph nodes around superior mesenteric vein remains controversial, as well as the necessity for splenectomy while doing splenic hilar lymphadenectomy or the necessity for distal gastric lymphadenectomy when the tumor diameter is less than 4 cm. In order to avoid postoperative pathological staging bias and to guide the further treatment after surger
出处
《中华胃肠外科杂志》
CAS
CSCD
北大核心
2018年第2期236-240,共5页
Chinese Journal of Gastrointestinal Surgery
基金
山西省自然科学基金（2013011044-1）
关键词
胃上部肿瘤
进展期
淋巴结清扫
预后
Upper stomach tumor, advanced
Lymph node dissection
Prognosis
