292例早期胃癌淋巴结转移规律的研究  

Study on lymph node metastasis in 292 natients with early gastric cancer

作　　者：黄宝俊[1] 鲁翀[1] 徐莹莹[1] 郑新宇[1] 徐惠绵[1] 

机构地区：[1]中国医科大学附属第一医院肿瘤外科,沈阳110001

出　　处：《中华外科杂志》2007年第3期192-195,共4页Chinese Journal of Surgery

基　　金：辽宁省科技厅资助项目(2005225007-3)

摘　　要：目的分析早期胃癌淋巴结转移规律,为合理选择手术方式提供依据。方法选择施行根治手术、临床病理资料完整、检取淋巴结总数在15枚以上的292例早期胃癌患者为研究对象,分析各站、号淋巴结转移率及其影响因素。结果所有患者淋巴结转移率为14.7%,其中黏膜内癌为6.4%,黏膜下癌为22.4%。多因素分析表明:浸润深度、淋巴管癌栓是影响早期胃癌淋巴结转移的独立危险因素。各站、号淋巴结转移率为:第Ⅰ站12.7%,频率由高到低依次为第6、3、4、1、5号淋巴结;第Ⅱ站7.2%,频率依次为第7、8a 号淋巴结;第Ⅲ站0.34%。癌灶最大长径≤2.0 cm 伴淋巴结转移的早期胃癌均为凹陷型;伴淋巴结转移的隆起型早期胃癌最大长径均≥3.0 cm。结论癌灶最大长径≤2.0 cm、隆起型、黏膜内癌应行缩小手术;癌灶最大长径≤3.0 cm 的凹陷型或>3.0 cm 的隆起型应行 D1_+第7、8a 号淋巴结清除术;对于>3.0 cm 的凹陷型癌应选择标准根治术(D2)为宜。Objective To evaluate the status of lymph node metastasis （LNM） and reasonable procedure in early gastric cancer （EGC）. Methods Two hundred and ninety-two patients with histologically proven mueosal or submueosal gastric cancer who underwent gastreetomy/lymphadenectomy were included in this study. The numbers of total dissected lymph node were all above 15 in all patients. The clinical characteristics, pathologic features, and LNM were assessed by univariate and multivariate analysis. Results LNM were observed in 43 of 292 eases （ 14. 7% ）, and 6. 4% in mueosal lesions and 22. 4% in submucosal lesions. The LNM was identified in 12.7% at the first level, 7.2% at the second level and 0. 34% at the third level. The LNM frequency was found in the 6, 3, 4, 1,5 lymph node （from high to low） consequently at the first level and the 7, 8a lymph node at the second level. The EGC with nodal involvement and the tumors 〈 2. 0 cm in diameter were all depressed type. The diameter of elevated type with LNM was no less than 3.0 cm in this series. The depth of invasion and lymphatic vessel involvement were independent influencing factors in LNM on multivariate analysis （P 〈 0. 05）. Conclusions Less extensive surgery might be considered for the elevated type EGC, and tumors ≤ 2.0 cm in diameter and mucosal lesions. Gastrectomy with D1 plus No. 7, 8a lymphadenectomy might be carried out in the depressed type/≤3.0 cm in diameter, or in the elevated type/ 〉 3.0 cm in diameter. With respect to the depressed type EGC/tumors 〉 3.0 cm in diameter, gastreetomy with D2 lymphadenectomy is proper.

关 键 词：胃肿瘤 淋巴转移 外科手术 

分 类 号：R735.2[医药卫生—肿瘤]