早期胃癌淋巴结转移规律与腹腔镜手术方式的探讨  

Characteristics of lymph node metastasis in early gastric cancer and reasonable laparoscopic surgery

作　　者：宋涛[1] 李溪[1] 丁丹[1] 柯重伟[1] 

机构地区：[1]上海市第二军医大学长海医院,上海200433

出　　处：《腹腔镜外科杂志》2015年第5期356-361,共6页Journal of Laparoscopic Surgery

摘　　要：目的:探讨不同组织学类型早期胃癌的淋巴结转移情况,为腹腔镜胃癌缩小手术提供理论依据。方法:回顾分析2004年1月至2012年12月收治的696例早期胃癌患者,对比不同组织学类型早期胃癌的临床病理特征,并对其与淋巴结转移的相关性进行单因素及多因素分析。结果:与其他类型腺癌相比,早期印戒细胞癌更常见于女性,肿瘤部位常见于胃体中部,印戒细胞癌患者通常是小于50岁的患者(P<0.001),隆起型、混合型少见(P<0.001),差异有统计学意义,在黏膜下入侵的发生率、淋巴管肿瘤浸润、淋巴结转移方面,印戒细胞癌与高分化腺癌相似,但与中、低分化腺癌差异有统计学意义(P<0.001)。中、低分化腺癌,肿瘤直径≥20 mm,黏膜下入侵,淋巴管肿瘤浸润,为淋巴结转移的独立危险因素。肿瘤直径<20 mm,且无淋巴管肿瘤浸润的黏膜内印戒细胞癌无淋巴结转移,肿瘤直径≥20 mm,且无淋巴管肿瘤浸润的黏膜内印戒细胞癌表现出较低的淋巴结转移率。结论:印戒细胞型早期胃癌的淋巴结转移率及黏膜下入侵率与高分化腺癌相似,无淋巴管肿瘤浸润的印戒细胞型黏膜内胃癌患者可行腹腔镜缩小手术。Objective： To compare the clinicopathologic features of different types of early gastric cancer （ EGC ）, and to inves- tigate the risk factors of lymph node metastasis （LNM） and to provide a basis for laparoscopic surgery of narrowing range. Methods ： A retrospective study was performed on 696 EGC patients who had been treated in the Department of General Surgery of Changhai Hospital between Jan. 2004 and Dec. 2012. Clinieopathologie features were compared between different histological types and investigated by uni- vac＇late and muhivariate analysis for their possible relationship with LNM. Results：A total of 696 patients were enrolled, in early gastric signet ring cell carcinoma （SRC） ,SRC was more frequent in women and more common at the mid-body than differentiated adenocarci- noma. SRC was more common in patients younger than 50 years of age （ P 〈 0. 001 ） and the elevated and mixed type was less common in SRC than other adenocareinomas （ P 〈 0. 001 ）. The incidence of submucosal invasion, lymphatic vessel involvement （LVI） , and LNM in SRC were similar to well-differentiated adenocarcinoma, but significantly different compared with moderately and poorly differ- entiated adenocarcinoma （ P 〈 0.001 ）. Moderately and poorly differentiated group, tumor size greater than 20 ram, submucosal invasion, and LVI were independent risk factors predicting LNM. Intramucosal SRC less than 20 mm and without LVI had no LNM,intramueosal SRC more than 20 mm and without LVI had a lower LNM rate. Conclusions ： Rate of LNM and submucosal invasion in early SRC are as low as those in early well-differentiated adenocarcinoma. Signet ring intramucosal EGC without LVI can be performed by laparoscopic surgery of narrowing range.

关 键 词：早期胃癌 淋巴结转移 临床病理特征 腹腔镜检查 

分 类 号：R735.2[医药卫生—肿瘤]