分化型黏膜下胃癌淋巴结转移的危险因素探讨  

Study of the predictive factors of lymph node metastasis in differentiated submucosal gastric cancer

作　　者：李华[1] 路平[1] 张静[2] 徐惠绵[1] 王舒宝[1] 陈峻青[1] 

机构地区：[1]中国医科大学第一附属医院肿瘤外科,辽宁沈阳110001 [2]河北医科大学生理研究室,河北石家庄050017

出　　处：《中国普通外科杂志》2008年第10期961-964,共4页China Journal of General Surgery

基　　金：辽宁省教育厅资助项目(2004D182)

摘　　要：目的探讨分化型黏膜下胃癌淋巴结转移的危险因素,为EMR术后病理学诊断为黏膜下癌的患者制定合理术式提供理论依据。方法回顾性分析70例分化型黏膜下癌的临床病理资料,分析临床病理特征与淋巴结转移的关系。结果多因素分析表明,淋巴管癌栓和癌灶中存在未分化癌细胞成分(危险因素)与淋巴结转移有关,两指标组间差异有显著性(P<0.05)。两危险因素都存在者,淋巴结转移率为75.0%,无危险因素者,淋巴结转移率为0。在11例26个淋巴结转移的患者中,17个淋巴结转移在N1,9个淋巴结转移超过N1。结论淋巴管癌栓和癌灶中存在未分化癌细胞成分是分化型黏膜下癌淋巴结转移的独立危险因素。对于黏膜内癌行EMR术后病理学检查是黏膜下癌的患者,上述危险因素可作为判断是否需要进行附加手术的简单标准。Objective To study the predictive factors of lymph node metastasis in differentiated submueosal gastric cancer （ DSMGC ） , and to establish an objective and rational criteria of indications of endoscopic mueosal resection for DSBGC. Methods Clinieopathologlcal data from 70 patients with differentiated submueosal gastric cancer were collected and the relationship between their clinieopathological characteristics and lymph node metastasis was retrospectively analyzed by univariate and multivariate analysis. Results Lymphatic vessel tumor embeli and presence of intermingled components of undifferentiated cancer cells （ risk factors ） were significantly associated with lymph node metastasis （P〈0.05）. Patients with beth risk factors had lymph node metastasis rate of 75 % , patients with no risk factors had no lymph node metastasis. There were 26 lymph node metastases in 11 patients, and 17 of the metastasie lymph nodes were in N1 , while 9 metastatic lymph nodes were beyond N1. Conclusions Lymphatic vessel tumor emboli and presence of intermingled components of undifferentiated cancer cells were independently related to lymph node metastasis in differentiated submucosal gastric cancer. It is rational for the paitients with one or two independent risk clinicopathological characteristics to undergo an endoscopic mucosal resection.

关 键 词：胃肿瘤/病理学 淋巴转移 危险因素 

分 类 号：R735.2[医药卫生—肿瘤]