胃癌根治术保留胰脾功能清除脾门和脾动脉干淋巴结的临床意义  

Resection of gastric carcinoma with preserving of the spleen and pancreas and functional clearance of lymph nodes of the spleen hillus and splenic artery

作　　者：秦环龙[1] 林超鸿[1] 

机构地区：[1]上海市第六人民医院外科,200233

出　　处：《中华外科杂志》2001年第12期904-907,共4页Chinese Journal of Surgery

摘　　要：目的　探讨胃癌根治术保留胰脾功能清除脾门和脾动脉干淋巴结 (即No10、No11)的合理性和可行性。　方法　分析 439例手术切除的胃贲门、体部和全胃癌侵入胰脾情况 ;对 5 4例胃癌患者在术中从贲门和体部浆膜下注入亚甲兰观察胃的淋巴流向 ;6 3例胃癌采用保留胰脾功能性清除No10、No11淋巴结方法 ,与同期保胰法和胰脾切除法比较 ,分析No10、No11淋巴结转移率 ,观察术后并发症发生率和生存率。　结果　 439例胃贲门、体部和全胃癌侵入胰脾机会不多 ,分别为 5 7%(2 5 /4 39)和 2 3%(10 /4 39) ;5 4例胃的美兰淋巴引流不进入脾脏和胰腺内。保留胰脾法、保胰法和胰脾切除法 3组No10、11淋巴结转移率分别为 17 5 %(11/6 3) ,19 1%(12 /6 3) ;2 0 8%(4 5 /2 16 ) ,2 5 %(5 4/2 16 ) ;2 0 %(6 /30 ) ,2 3%(7/30 ) ,差异无显著意义。 6 3例保留胰脾法术后并发症发生率和病死率均较保留胰法和胰脾联合切除法低 ,而生存期较高 ,5、10年生存率分别为 5 7 5 %、5 2 %,5 7 4 %、47 4 %和37 3%、30 %。Ⅱ、Ⅲa期患者保留胰脾手术的 5、10年生存率明显改善。　结论　保胰脾法是一个安全、切实可行的保留脏器功能的胃癌手术 ,术后并发症低、生存率高。尤对Ⅱ、Ⅲa期患者应行保留胰脾手术。Objective To study the practical effects of the preserved spleen and pancreas and functional clearance of lymph nodes of the spleen hillus and splenic artery for gastric carcinoma. Methods Spleen and pancreatic involvement was retrospectively reviewed in 439 cases of resectable carcinoma of the gastric cardia,gastric corpus and total stomach. During gastric operation, 2 ml methylence blue was injected into the subserosal space of the gastric cardia or corpus to observe the spreading of lymphatic flow of the stomach in 54 cases. The No10, No11 lymph node metastasis rates, postoperative complications and survival rates were observed in 63 case of gastric carcinoma that had received gastrectomy with preservation of the spleen and pancreas(PSP) and functional clearance of lymph nodes of the spleen hillus and splenic artery. Results Invasion of gastric cancer into the pancreas and spleen occurred in 5.7%(25/439) and 2.3% (10/439) respectively. Methylence blue was injected into the subserosal space of the stomach without diffusion into the spleen and pancreas. The No10, No11 lymph node metastasis rates of PSP, pancreas preservation (PR) and pancreas and spleen resection(PSR) were 17.5%(11/63),19.1%(12/63);20.8%(45/216),25%(54/216);20%(6/30),23%(7/30), respectively (P>0.05). The occurrence of postoperative complications and mortality was lower in patients with PSP than those with spleen and parts of pancreas resected, whereas the survival rate was higher in patients with PSP. The 5-year and 10-year survival rates of gastic carcinoma in stage Ⅱ, Ⅲa were markedly improved in patients with PSP. Conclusions PSP for patients with gastric cancer is safe and functional resectable. The occurrence of postoperative complications is lower and the survival rates are higher in patients with PSP than those with spleen and part of pancreas resected. PSP is benefial to those with gastric carcinoma in stage Ⅱ, Ⅲa.

关 键 词：胃肿瘤 胃切除术 胰腺 脾 生存率 

分 类 号：R735.2[医药卫生—肿瘤] R730.56[医药卫生—临床医学]