早期胃癌不同淋巴结清除术的合理评价  

Assessment on different modes of lymphadenectomies in the treatment for early gastric cancer

作　　者：黄宝俊[1] 鲁翀[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：《中华肿瘤杂志》2007年第4期293-296,共4页Chinese Journal of Oncology

基　　金：辽宁省科技厅资助项目（2005225005）

摘　　要：目的 合理选择早期胃癌不同淋巴结清除术式。方法 以临床病理资料完整的325例早期胃癌为研究对象，总结其各站淋巴结转移规律及其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 全组淋巴结转移率为14．8％，转移度为3．0％。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，而No．1、9、11P、12a和14v淋巴结几乎无转移。胃中部癌第Ⅰ站淋巴结转移率为13．8％，No．1、3、5、6淋巴结有转移；第Ⅱ站淋巴结转移率为6．9％，仅№．7、8a淋巴结有转移。大癌灶（〉3．0cm）、黏膜下癌、低分化和淋巴管癌栓阳性者的第Ⅰ、Ⅱ站淋巴结转移率较小癌灶（≤3．0cm）、黏膜内癌、高分化和淋巴管癌栓阴性者明显增高（P〈0．05）。结论 单纯D，或D1＋No．7淋巴结清除术适合于癌灶直径≤1．0cm或黏膜内癌；D1＋No．7、8a淋巴结清除术适合于早期胃中、下部癌中直径〉1．0cm、凹陷型、黏膜下癌，其中癌灶直径〉3．0cm、淋巴管癌栓阳性者应加行No．1、9淋巴结清除；标准D：、D，淋巴结清除术应尽量避免施行。Objective To evaluate the efficacy of different modes of lymphadenectomies in the surgical treatment for early gastric cancer （EGC） in order to provide evidence for reasonable selection of lymphadenectomy for the ECG. Methods The clinicopathological data of 325 EGC patients were reviewed. The lymph node metastasis （LNM） rate of different levels and the efficiency of different modes of lymphadenectomies were analyzed, and the correlation between LNM and clinicopathological features were analyzed either. Results The overall LNM rate in the EGC was 14.8%, and the overall LNM degree was 3.0%. In the ECG located in the lower third of the stomach, the rate of first level nodal involvement was 14.5%, which was detected in the No. 3, No. 4, No. 5, No. 6 station of draining lymph nodes for the stomach; and it was 6.9% in the second level lymph nodes which were seen in the No. 7 and No. 8a station. There was rare metastasis in the No. 1, No. 9, No. llp, No. 12a and No. 14v station. In the ECG located in the middle third of the stomach, the rate of first level nodal involvement was 13.8%, which was found in the No. 1, No. 3, No. 5 and No. 6 station, and it was 6.9% in the second level nodes only seen in the No. 7 and No. 8a station. The LNM rate was significantly higher in the lesion larger than 3.0 cm in diameter, or having submucosa invasion, or being poorly differentiated, or with lymphatic involvement than that of the lesion smaller than 3. 0 cm in diameter, without mucosa invasion or lymphatic involvement, or being well differentiated （P 〈 0. 05 ）. Conclusion Based on our data, it is suggested that the D1 or D1 ＋ lymphadenectomy of the No. 7 station of lymph node may be suitable for the lesion smaller than 1.0 cm in diameter or only located in the mucosa; the D1 ＋ lymphadenectomy of the No. 7 and No. 8a station of lymph nodes may be suitable for the lesion larger than 1.0 cm in diameter, or being depressed type or with submucosa invasion in the middle and/or lower third of the stomach. For the lesion

关 键 词：胃肿瘤 淋巴结转移 淋巴结清除术 合理评价 

分 类 号：R686[医药卫生—骨科学]