胃癌D3淋巴结清扫术的临床价值  

Clinical Significance of D3 Lymph Node Dissection in Radical Gastrectomy

作　　者：顾钧[1] 崔龙[1] 沈定丰[1] 

机构地区：[1]上海交通大学医学院附属新华医院普外科,上海200092

出　　处：《中国现代手术学杂志》2008年第1期9-12,共4页Chinese Journal of Modern Operative Surgery

摘　　要：目的探讨D3淋巴结清扫术对进展期胃癌患者的预后、并发症和生活质量的影响。方法对2000年4月至2002年10月收治的132例进展期胃癌患者进行前瞻性研究,随机分为D3组74例,行D3淋巴结清扫术;D2组58例,行D2手术。结果D2组和D3组术后1、2年的生存率无差别,但3至5年的生存率D2组分别为56.9%、46.6%和36.2%,D3组71.6%、62.2%和56.8%,两者有明显差异(P<0.05)。术后并发症发生率D2组和D3组分别为8.6%和13.5%,两组比较无明显差异(P>0.05),但D2组手术时间为(182.0±32.3)min,明显短于D3组的(236.0±23.7)min(P<0.05)。在生活质量评估方面,D2组和D3组患者术后2、4、6个月组间各项特殊症状评分指标差异无显著性意义(P>0.05)。结论进展期胃癌D3淋巴结清除术是安全的,能够显著改善患者的预后且不影响生活质量。Objective To study the clinical significance of D3 lymph node dissection in radical gastrectomy for Stage Ⅱb～Ⅲ gastric carcinoma patients.Method From Apr.2000 to Oct.2002,132 cases of advanced gastric carcinoma patients were randomly divided into 2 groups,including 74 cases of Group D3 who received D3 lymph node dissection,and 58 cases of Group D2 received D2 lymph node dissection respectively.Result There was no difference between Group D2 and D3 in 1-and 2-year survival rates（P〉0.05）.But the 3-,4-and 5-year survival rates of Group D2 were significantly lower than those of Group D3,which was 56.9% VS 71.6%,46.6% VS 62.2%,36.2% VS 56.8%,respectively（P〈0.05）.The complication rate of Group D2 was 8.6%,which had no difference compared with 13.5% of Group D3（P〉0.05）.And the operation time of D2 was shorter than D3,（182.0±32.3）min VS（236.0±23.7） min,P〈0.05.There was no significant difference in all indexes of quality of life between the two groups 2,4,6 months after operation.Conclusion D3 lymph node dissection is safe to the advanced gastric carcinoma patients,and it can improve the prognosis effectively without the quality of life worsen.

关 键 词：胃肿瘤 淋巴结切除术 

分 类 号：R735.2[医药卫生—肿瘤]