清扫No.14v淋巴结对进展期胃下部癌临床意义研究  

Clinical significance of No.14v lymph node dissection in advanced lower gastric cancer

作　　者：杨佳华[1,2] 陈磊[1] 董平[1] 顾钧[1] 李茂岚[1] 吴文广[1] 吴向嵩[1] 张林[1] 丁琦晨[1] 翁昊[1] 丁倩[1] 穆嘉盛[1] 刘颖斌[1] 

机构地区：[1]上海交通大学医学院附属新华医院普外科,上海200092 [2]上海中医药大学附属普陀医院普外科,上海200062

出　　处：《中国实用外科杂志》2013年第10期874-877,共4页Chinese Journal of Practical Surgery

摘　　要：目的探讨进展期胃下部癌中临床病理因素对No.14v淋巴结转移的影响及No.14v淋巴结转移对预后的意义,指导术中淋巴结清扫范围选择。方法回顾性分析上海交通大学医学院附属新华医院2008年1月至2008年12月间115例进展期胃下部癌行胃癌根治术(D2淋巴结清扫+No.14v淋巴结清扫)病人的临床病理资料。分析临床病理因素对No.14v淋巴结转移的影响,并分析No.14v淋巴结对于病人生存期的影响。结果全组病例No.14v淋巴结转移率(阳性淋巴结数目/清扫淋巴结的总数)为18.41%(37/201),No.14v淋巴结转移率(转移病人数/病人总数)为20.87%(24/115)。No.14v淋巴结转移和肿瘤的大小、分化程度、浸润深度、TNM分期及有无No.6淋巴结转移有关(P<0.05),而与病人的性别、年龄、Bormann分型无关(P>0.05)。多因素分析结果提示肿瘤大小、浸润深度、TNM分期及No.6淋巴结转移为No.14v淋巴结转移的独立危险因素(P<0.05)。全组病例术后3年平均生存期为40个月。No.14v淋巴结阴性的病人3年存活率为73.67%,No.14v淋巴结阳性的病人3年存活率为37.5%,两组比较差异具有统计学意义(P<0.05)。结论对进展期胃下部癌病人行No.14v淋巴结清扫是必要且安全可行的。Objective To study if elinicopathological variates are related to No.14v lymph nodes metastasis in advanced lower gastric cancer and how the prognostic significance of lymph node metastasis can instruct the optimal choice in lymph node dissection. Methods The clinicopathological data of 115 patients received radical resections （D2＋No. 14v） between January 2008 and December 2008 in Department of General Surgery, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine were analyzed retrospectively. The relationship between different clinicopathological factors and lymph node metastasis was analyzed. Besides, how lymph node metastasis influenced prognosis of patients was investigated. Results The overall No.14v lymph node metastasis rate （metastatic/examined lymph node） was 18.41% （37/201）. The positive rate of No.14v lymph nodes was 20.87% （24/115）. Metastasis to the No.14v lymph nodes was associated with tumor diameter, tumor cell grading, depth of invasion, TNM staging and No.6 lymph nodes metastasis （P〈 0.05）. Meanwhile it was not associated with gender, age or Bormann types （P〉 0.05）. Multivariate analysis showed that tumor size, depth of invasion, TNM stage and No.6 lymph nodes metastasis were independent risk factors for No.14v lymph nodes metastasis （P 〈 0.05）. Average three-year survival period in the whole group was 40 months. The three-year survival rate of patients with negative No. 14v lymph nodes was 73.67%, which was significantly higher than those with positive No.14v lymph nodes （37.5%） （P〈0.05）. Conclusion No.14v lymph node dissection for advanced lower gastric cancer is necessary and feasible.

关 键 词：进展期胃癌 淋巴结清扫 NO 14v淋巴结 

分 类 号：R6[医药卫生—外科学]