胃癌第16组淋巴结转移与D_4式根治术的临床病理研究  

A Clinico-pathological Study on Para-aortic Lymph Node Metastasis and D_4 Dissection for Advanced Gastric Cancer.

作　　者：燕敏[1] 徐鸿[1] 尹浩然[1] 朱正纲[1] 李树发[1] 薛建元[1] 

机构地区：[1]上海第二医科大学附属瑞金医院外科,200025

出　　处：《外科理论与实践》2000年第2期104-106,110,共4页Journal of Surgery Concepts & Practice

摘　　要：目的：为试行提高胃癌根治术手术的疗效，阐明胃癌生物学特性与第１６组淋巴结转移的关系，从而提出合适的Ｄ４式根治术指征，探讨此术式的可行性和意义。方法：对我院自１９９５年９月至１９９８年１１月所行的５６例无远处转移的Ｄ４式根治术病例，就反映肿瘤生物学特性的各临床、病理参数进行分析，祈能对Ｄ４式根治术提出合适的手术指征。结果：在５６例Ｄ４式根治术中，发现有第１６组淋巴结转移者１０例，转移率为１７．９％；而于浸润型胃癌、肿瘤直径大于５ｃｍ、肿瘤侵及浆膜以及第２、３站淋巴结受累时，第１６组ＬＮ转移率明显增高（Ｐ＜０．０５）；在第１６组的各分区ＬＮ中又以１６Ａ２和Ｂ１区的转移率更高。全组无手术死亡率，手术并发症也未见明显增加。结论：进展期胃癌中有相当一部分发生第１６组ＬＮ转移，且与胃癌各生物学特性参数相关。在正确掌握手术适应证的基础上，Ｄ４式胃癌根治术是相对安全可行的，其对胃癌手术的彻底性和远期疗效的意义，有待进一步积累经验。(1)to assess the significance of D_4 dissection in treating patients with advanced gastric cancer(AGC); (2)to elucidate the relationship between the para-aortic lymph node(No.16 LN) metastasis and the biological behavior of gastric cancer, and (3) to make out the appropriate indications for D_4 dissection. Methods: 56 cases of AGC without remote metastasis were subjected to D_4 dissection during the period from September 1995 to November 1998 in Ruijin Hospital. Clinico-pathological studies were carried out for all the cases. Results: Ten of the 56 cases were No.16 LN positive(17.9%) and the positive rate is significantly increased in cases where the tumor was larger than 5cm in diameter, belonging to the infiltrative type, with serosal involvement and/or N3 positive(p< 0.05). The incidence of complications occurring in our D_4 cases was not noticeably increased and there was no operative mortality. Conclusions: Para-aortic lymph node metastasis do occur in some of the advanced gastric cancer patients. Selective D_4 procedure appears to be relatively safe and feasible. The impact of D_4 procedure on the long-term prognosis of AGC remains to be clarified by further studies.

关 键 词：胃肿瘤 淋巴结转移 D4式胃癌根治术 

分 类 号：R735.2[医药卫生—肿瘤] R73－37[医药卫生—临床医学]