进展期胃癌的脾门淋巴结转移相关因素的研究(英文)  

Lymph Node Metastasis at the Splenic Hilum in Patients with Advanced Gastric Cancer

作　　者：郑国良[1] 赵岩[2,3] 郑志超[2,3] 于先强[1] 张涛[2,3] 

机构地区：[1]大连医科大学研究生院,辽宁大连116000 [2]辽宁省肿瘤医院胃外科,辽宁沈阳110042 [3]中国医科大学肿瘤外科,辽宁沈阳110042

出　　处：《现代生物医学进展》2013年第21期4064-4068,共5页Progress in Modern Biomedicine

基　　金：The current study was supported by"Liaoning BaiQianWan Talents Program"(2010921037);grant from National Ministryof human resources and social security of China(2011LX005);National Science Foundation of Liaoning Proince,China(201102110)~~

摘　　要：目的:探讨进展期胃癌脾门淋巴结(10组)转移的相关临床病理因素。方法:回顾分析了(2008-2011年)75例胃癌根治术伴10组淋巴结切除的进展期胃癌病例。分析了临床病理学因素和10组淋巴结转移的相关性。结果:本研究结果提示10组淋巴结转移的阳性率为52%。胃下部癌的转移率(20%)相对较低(P=0.000),大弯侧肿瘤的转移率高达76.2%。病灶的侵润深度及病理TNM分期与10组淋巴结阳性率密切相关,组织学类型或分化程度与10组淋巴结转移无统计学相关。病灶小于3 cm病例的10组淋巴结转移的阳性率为0%,而大于9 cm或Borrmann-IV的肿瘤患者的10组淋巴结转移的阳性率为100%。结论:10组淋巴结转移的高危因素包括:1.中上部胃癌;2.肿瘤位于胃大弯侧;3.大于3 cm;4.侵达胃壁浆膜层。含以上高危因素的进展期胃癌根治手术中,建议常规行术中快速冰冻检查10组淋巴结是否存在转移;含2个以上高危因素的进展期胃癌建议行脾切除术,或如果技术条件具备应行保留脾的10组淋巴结清扫术以便最终获得R0切除。Objective： To investigate the clinicopathological factors correlated with No.10 lymph node（lymph node located in splenic hilum,#10LN） metastasis in advanced gastric cancer（AGC）.Methods： 75 AGC patients undertook curative gastrectomy with lienectomy or spleen reserved #10LN resection were retrospectively studied.The correlation between clinicopathological factors and #10LN metastasis was analyzed.Results： There was 52.0% positive #10LN metastasis by current dataset.Tumors located in the lower portion of the stomach showed lower risk of #10LN metastasis（20.0%,P=0.000）,and tumors of greater curvature showed a high #10LN metastasis rate（76.2%）.Tumor infiltration depth and pathological TNM stage were significantly correlated with #10LN metastasis.Gross appearance or histological differentiation was not statistically correlated with #10LN invasion.Tumors 3 cm had no #10LN metastasis.Tumors 9 cm and Borrmann-IV GC exhibit 100% #10LN metastasis.Conclusions： The high risk factors correlated with #10LN metastasis included： 1.located in the upper or middle portion of the stomach,2.located in the greater curvature,3.large tumors of over 3 cm,4.Invade to serosa.For AGCs with these high risk factors,it was recommend a routine fast frozen pathological examination.Lienectomy or if technologically possible,spleen reserved #10LN dissections should be undertaken for tumors with two or more high risk factors to gain a R0 resection.

关 键 词：胃癌 淋巴结清扫 D2手术 

分 类 号：K735.2[历史地理—历史学]