残胃癌的淋巴结转移规律与手术治疗  

A study on the lymph node metastasis of stump gastric cancer and its surgical therapy

作　　者：韩少良[1] 崔向东[2] 邵永孚[1] 

机构地区：[1]中国医学科学院肿瘤医院腹部外科,北京100021 [2]辽宁省肿瘤医院外科

出　　处：《中华普通外科杂志》2000年第7期423-425,共3页Chinese Journal of General Surgery

摘　　要：目的　探讨残胃癌淋巴结转移规律及其合理的根治术式。方法　回顾性分析我院从 1979年 3月至 1997年 9月收治的 6 4例残胃癌患者的淋巴结转移规律、手术方式及其疗效。结果　本组残胃癌患者 6 4例 ,占同期手术病人的 2 1%。其中包括治愈性切除者 30例 ,其淋巴结转移率分别为第 1组 5 9 1% (13/ 2 2 )、2组 33 3% (6 / 18)、3组 80 0 % (2 4/ 30 )、4组 46 7% (7/ 15 )、7组 2 5 0 %(3/ 12 )、8组 36 4% (4 / 11)、9组 40 0 % (6 / 15 )、10组 6 0 0 % (6 / 10 )、11组 72 3% (8/ 11)、12组 33 3 %(12 / 36 )、13组 11 1% (4 / 36 )、16组 2 1 4% (3/ 14)、111组 5 0 % (1/ 2 )及空肠系膜淋巴结转移率 16 7%(3/ 18)。本组病例中仅行开腹探查的 6例患者均于 1年内死亡 ,而治愈性切除病例 (n =30 )的 1、3、5年生存率明显好于非治愈性切除病例 (n =2 8)〔10 0 %对 82 1% ,73 3 %对 32 1% ,36 7%对 3 6 %(χ2 值分别为 10 5 6、11 6 7、7 76 ,P <0 0 1)〕。结论　①B Ⅰ式重建残胃癌病例的切除范围包括胃十二指肠吻合口 ,并清除第 1、2、3、4、7、8、9、10、11组淋巴结 ,必要时一并清除第 12、14、13组淋巴结 ;②B Ⅱ式重建残胃癌病例的切除范围包括胃肠吻合口左右的口、肛侧空肠各 10cm ,同?Objective To investigate the pattern of lymph node metastasis and optimal surgery for patients with gastric stump cancer.[WT5”HZ] Methods[WT5”BZ] Metastasis of the lymph node, operative procedure and prognosis of patients with gastric stump cancer during March 1979 and December 1997 were retrospectively analyzed.[WT5”HZ] Results[WT5”BZ] 64 patients (2.1%) with gastric stump cancer were enrolled in this study during the period, including 30 patients undergoing curative gastrectomy, and the metastatic rates of lymph node were as following: 59 1%(13/22) in right cardia node (group 1), 33 3% (6/18) in left cardia (group 2), 80 0% (24/30) in lesser curvature (group 3), 47% (7/15) in greater curvature (group 4), 25%(3/12) in nodes along the root of left vessel (group 7), 36 4% (4/11) in nodes along common hepatic artery (group 8), 40% (6/15) along celiac artery (group 9), 60% (6/10) in splenic hilum (group 10), 73% (8/11) along splenic artery (group 11), 33% (12/36) within hepatoduodenal ligament (group 12), 12%(4/36) in retropancreatic region (group 13), 21% (3/14) in para aortic area (group 16), 50% (1/2) in supra diaphragm (group 111),and 16 7% (3/18) in jejunal mesentery,respectively All six patients undergoing laparotomy only died within one year, and the 1,3,5 year survival rates of patients ( n =30) with curative gastrectomy were significantly better than those of patients ( n =28) with palliative gastrectomy 〔100% (30/30) v s 82.1%(18/28), 73 3% (22/30) v s 32 1% (7/28) and 36 7%(11/30) v s 3 6% (1/28), respectively〕 (χ 2=10 56, 11 67 and 7 76, P <0 01, respectively).[WT5”HZ] Conclusions[WT5”BZ] ①Rational surgical procedure for Billroth Ⅰgastric stump cancer patients consists of removal of the gastroduodenostomy and lymph nodes of groups 1, 2, 3, 4, 7, 8, 9, 10, and groups 12, 14 and 13, if necessary. ②Billroth Ⅱgastric stump cancer patients need to remove 10 cm of jejunum distal and proximal to the original anastomosis, to dissect lymph node in the

关 键 词：胃残端癌 外科手术 肿瘤转移 淋巴结转移 

分 类 号：R735.2[医药卫生—肿瘤]