【作者】 黄宝俊； 徐惠绵；

【Author】 Surgical Oncology Department, the First Hospital of China Medical University, Shenyang, 110001,China.

【机构】 中国医科大学附属第一医院肿瘤外科；

【摘要】 目的:合理选择早期胃癌不同淋巴结清除术式。方法:以施行根治手术且临床病理资料完整的325例早期胃癌为研究对象。其中胃下部癌(L／LM)248例,中部癌(M／ML／ MU)58例,上部癌(U／UM)13例,全胃广泛癌(UML)6例, 远端胃切除296例,近端胃切除9例,全胃切除20例,其中全胃联合脾切除2例, 淋巴结清除术中D1 77例,D1+No． 759例,D1 57例,D2 94例,D3 25例,扩大切除13例(指远隔淋巴结的廓清)。粘膜内癌(m)153例、粘膜下癌(sm) 172例,大体类型中隆起型22例、浅表型39例、凹陷型264 例,癌灶最大径≤1．0 cm 26例、1．1～2．0 cm 118例、2． 1～3．0 cm 60例、>3．0 cm 121例,组织学类型中高中分化癌142例,低分化癌183例。总结各站淋巴结转移规律,不同淋巴结清除术的效率,并分析淋巴结转移与病理生物学行为的相关性。结果:全组病例中伴淋巴结转移者48例,转移率为14．8％,转移度为3．0％。其中m癌5．9％,sm癌22． 7％, 高中分化癌9．2％,低分化癌19．1％,差异均具有显著性(x 2=18．14,p<0．001,x 2=6．32,p=0．012),而在肿瘤部位和大体类型间无统计学差异(p>0．05)。胃下部癌第 1站淋巴结转移率为14．5％,各号淋巴结均有转移,第Ⅱ站淋巴结转移率为6．9％,以No．7、8a淋巴结转移率较高,转移率分别为5．6％、2．8％,而No．1、9、11p、12a、14v淋巴结几乎无转移。其中1例出现No．1淋巴结转移,为m癌、直径7．0 cm、凹陷型、未分化和印戒细胞癌,2例出现No．9 淋巴结转移,分别为sm癌、直径4．0 cm、Ⅲ型、低分化癌和sm癌、直径7．0 cm、Ⅲ型、高分化癌。第Ⅲ淋巴结转移率为0．8％,无远隔淋巴结转移病例。胃中部癌第1站淋巴结转移率为13．8％,其中No．1、3、5、6淋巴结有转移,转移率分别为5．2％、10．3％、1．7％和1．7％, 第Ⅱ站淋巴结转移率为6．9％,仅No．7、8a淋巴结有转移,转移率分别为5．2％和1．7％。单因素分析发现大癌灶(>3．0 cm)、sm癌、低分化、淋巴管癌栓阳性者第I、Ⅱ站淋巴结转移率比小癌灶(≤ 3．0 cm)、m癌、高分化、淋巴管癌栓阴性者明显增高(p< 0．05),m癌或直径小于1．0 cm者均无第Ⅱ站淋巴结转移, 低／未分化者第Ⅱ站淋巴结转移有增多趋势,但差异无显著性(p=0．058)。结论:D1／D1+No．7淋巴结清除术适合于癌灶直径≤1．0 cm或m癌,D1+No7、8a淋巴结清除术适合于中、下部早期胃癌中直径>1．0 cm、凹陷型、sm癌,其中癌灶直径>3．0 cm、淋巴管癌栓阳性者应加行No．1、9淋巴结清除,标准D2、D3淋巴结清除术应尽量避免施行。更多还原

【Abstract】 Objective: To choose different lym-phadenectomy in the early gastric cancer (EGC) reasonably. Methods: A total of 325 EGC patients were investigated whose clinicopathological data were recorded in detail. The lymph node metastasis (LNM) regularity in the different levels and the efficiency of different lym-phadenectomies were analyzed, and the correlation between LNM and clinicopathological factors were assessed, too. Results: The LNM rate in the EGC wasl4.8%, and the LNM degree was 3.0%. In the lower third of the stomach the first level nodal involvement rate was 14.5% which was seen in the station of no.3,4,5,6 and 6.9% was in the second level nodes which was seen in the station of no. 7, 8a and there was hardly metastasis in the station of no.1, 9, 11p, 12a, 14v. In the middle third of the stomach the first level nodal involvement rate was 13.8% which was seen in the station of no.1, 3,5,6 and 6.9% was in the second level nodes which was seen only in the station of no. 7, 8a. The LNM rate was higher in the lesion diameter more than 3.0 cm, submucosa invasion, poor differentiated and lymphatic involvement than that of diameter no more than 3.0 cm, mucosa invasion, well differentiated and lymphatic embolus negative (p < 0.05). Conclusion: The D1 or D1+ no.7 lymphadenectomy was suitable for the cancer diameter no more than 1.0 cm or only in the mucosa, The D1+ no.7,8a lymphadenectomy was suitable for the cancer diameter more than 1.0 cm, depressed type and submucosa invasion in the middle and/or lower third of the stomach and with respect to the diameter more than 3.0 cm the station of no.l and no.9 lymph node should be dissected, too, It is better not to execute the normalized D2/D3 lymphadenectomy in the EGC.更多还原