早期胃癌淋巴结转移规律及内镜切除的可行性  

Lymph node metastasis in early gastric cancer and the feasibility of endoscopic resection

作　　者：周羽翙 蔡振寨[1] 卢光荣[1] 叶梦思[1] 何云[1] 薛战雄[1] 

机构地区：[1]温州医科大学附属第二医院&育英儿童医院成人消化内科,浙江温州325000

出　　处：《中国内镜杂志》2015年第10期1023-1027,共5页China Journal of Endoscopy

摘　　要：目的探讨早期胃癌(EGC)淋巴结转移规律及其影响因素,指导内镜下治疗适应证的选择。方法回顾性分析417例行胃癌根治术治疗并经病理证实的EGC患者的临床病理资料,对患者的性别、年龄,肿瘤的大小、浸润深度、大体类型、部位、组织学类型与淋巴结转移的关系进行单因素及多因素分析。结果 EGC的淋巴结转移率为13.9%(58/417)。其中,黏膜内癌的淋巴结转移率为5.3%(11/208),黏膜下层癌的淋巴结转移率为22.5%(47/209)。性别(P=0.050)、肿瘤大小(P=0.047)、浸润深度(P=0.000)和组织学类型(P=0.000)是影响EGC淋巴结转移的独立危险因素。48例肿瘤直径≤2.0 cm的男性分化型黏膜内癌患者未见淋巴结转移。结论肿瘤直径≤2.0 cm的男性分化型黏膜内EGC患者可考虑行内镜切除术,但尚需后期大样本资料来验证该结果的准确性。【Objective】 To investigate the risk factors of lymph node metastasis（LNM） of early gastric cancer（EGC） and to explore the feasibility of endoscopic resection（ER）. 【Methods】Seven clinicopathological features of the 417 patients who underwent a curative gastrectomy were analyzed, including sex, age, tumor size, depth of tumor invasion, tumor location, microscopic type, and histological type. These factors were assessed for their possible association with lymph node metastasis by using univariate and multivariate analysis. 【Results】The incidence of lymph node metastasis of early gastric cancer was 13.9 %（58/417）, only 11（5.3%） intramucosal cancers compared with 47（22.5%） invasive cancers were associated with LNM. By multivariate analysis, sex（P = 0.050）, tumor size（P =0.047）, depth of tumor invasion（P = 0.000） and histological type（P = 0.000） were independent risk factors for lymph node metastasis. In male patients with differentiated type and mucosal invasion, which were 2.0 cm or less in tumor diameter, no LNM was detected.【Conclusion】We propose male patients with differentiated type intramucosal EGC2.0cm or less in size can be performed by EMR/ESD, but its accuracy remains to be verified by large sample analysis in the future.

关 键 词：早期胃癌 淋巴结转移 危险因素 内镜切除 

分 类 号：R735.2[医药卫生—肿瘤]