胃癌各组淋巴结的转移特点及其在实施合理根治术中的指导意义  

Features of metastasis in different lymph node groups and their significance in lymph node dissection in total gastrectomy for gastric cancer

作　　者：朱海涛[1] 赵宜良[1] 吴云飞[2] 徐惠绵[2] 

机构地区：[1]辽宁省肿瘤医院胃外科,沈阳110042 [2]中国医科大学第一附属医院肿瘤外科

出　　处：《中华肿瘤杂志》2008年第11期863-865,共3页Chinese Journal of Oncology

摘　　要：目的总结胃癌1～16组淋巴结转移的规律，探讨其对实施合理胃癌根治手术的指导意义。方法收集因胃癌行全胃切除术的73例患者的临床病理资料，淋巴结分组按照日本胃癌学会胃癌处理规约第13版进行，共分为16组，比较患者淋巴结转移率和转移度的差异。结果淋巴结转移率由低到高排列为第15、13、16、14v、12、10、9、11、8、2、6、7、5、1、4、3组，其中第15组淋巴结的转移率为1．4％，第3组淋巴结的转移率为65．8％，差异有显著的统计学意义（P〈0．01）。淋巴结转移度由低到高排列为第13、16、1、7、6、5、12、4、11、8、2、15、9、3、10、14v组，其中第13组淋巴结的转移度为10．7％，第14v组淋巴结的转移度为56．3％，差异亦有显著的统计学意义（P〈0．01）。结论胃癌全胃切除术时，对淋巴结转移率高的区域必须实施清扫；对转移度高的区域要实施完整清扫。第3组淋巴结活检阴性是缩小手术的绝对指征；第14v组淋巴结活检阴性是缩小手术的相对指征，而活检阳性是扩大手术的相对指征；第13和16组淋巴结活检阳性是姑息手术的绝对指征，而活检阴性、同时第14v组淋巴结活检阳性则是扩大手术的绝对指征。Objective To summarize the features of metastasis in different lymph node groups （from 1 to 16 groups） in gastric cancer patients treated by total gastrectomy, and evaluate their clinical significance in lymph node dissection. Methods The data of 73 gastric cancer patients with total gastrectomy and lymph node dissection from January 2004 to April 2006 were analyzed retrospectively. The lymph nodes were divided into 16 groups according to the 13th edition of gastric cancer treatment guideline of JGCA （The Japan Gastric Cancer Association）. The metastatic rate and degree of dissected lymph nodes in these patients were compared. Results The metastatic rates of lymph node groups in these patients from lower to higher were as follows： group 15, 13/16, 14v, 12, 10, 9, 11,8, 2, 6/7, 5, 1,4, 3. The lowest was the 15^th group lymph nodes （ 1.4% ）, the highest was the 3rd group （65.8%）, with a statistically significant difference between those two groups （ P 〈 0.01 ）. The metastatic degrees of the lymph node groups from lower to higher were as follows： 13, 16, 1, 7, 6, 5, 12, 4, 11, 8, 2, 15, 9, 3, 10, 14v. There was a statistically significant difference between the lowest group of lymph node （ 13^th group, 10.7% ） and the highest （ 14v^th, 56.3%, P 〈 0.01 ）. Conclusion In the radical total gastrectomy for patients with gastric cancer, it is suggested that the regional lymph nodes with higher metastatic rate should be resected necessarily, and the group with a higher metastatic degree should be dissected completely. If the result of sentinel lymph node biopsy in the 34 or 14v^th group is negative, the operation extent can be reduced. If positive, it should be extended. When the biopsy result in the 13^th or 16^th is positive, palliative operation may be indicated. However, if the biopsy result is negative in the 13^th or 16^th, but positive in the 14v^th group, extended operation is indicated.

关 键 词：胃肿瘤 胃切除术 淋巴结 合理根治术 

分 类 号：R686[医药卫生—骨科学]