保留脾脏的第10组与11组淋巴结整体清扫在胃癌D2根治术中的应用价值  

Application value of spleen-preserving No. 10 and 11 lymph nodes dissection in the D2 radical gastrectomy for gastric cancer

作　　者：何磊 文刚 涂从银[2] 陶应田 丁丁 

机构地区：[1]安徽医科大学第三附属医院胃肠外科,合肥230061 [2]安徽省肿瘤医院腹部肿瘤外科,合肥230001

出　　处：《中华消化外科杂志》2016年第11期1113-1117,共5页Chinese Journal of Digestive Surgery

基　　金：安徽省科技厅国际合作项目（1503062025）;合肥市科技局重大课题（2008-46、2010-25）

摘　　要：目的：探讨保留脾脏的第10组与11组淋巴结整体清扫在胃癌D2根治术中应用的可行性和安全性。方法：采用回顾性描述性研究方法。收集2013年1月至2016年5月安徽医科大学第三附属医院收治的32例进展期胃上部癌患者的临床病理资料。患者均由同一手术团队施行开腹根治性全胃切除（胃癌D2根治术）和托出式保留脾脏第10、11组淋巴结整体清扫术。观察指标：手术时间、术中出血量、第10组和11组淋巴结清扫时间、淋巴结清扫数目、阳性淋巴结数目、淋巴结阳性率、淋巴结转移率、肿瘤组织学分型、pTNM分期、术后住院时间、术后并发症（脾脏移位、脾扭转、脾梗死、吻合口漏、胰液漏、淋巴液漏）和随访情况。采用定期门诊复查和电话方式进行随访，随访内容为肿瘤学预后情况，随访时间截至2016年9月。正态分布的计量资料以±s表示。计数资料以率表示。结果：32例进展期胃癌患者中，胃体癌12例，贲门癌20例，均行开腹根治性全胃切除术（胃癌D2根治术），成功施行保留脾脏第10、11组淋巴结整体清扫。32例患者手术时间为（242±34）min，术中出血量为（98±67）mL。第10组淋巴结清扫时间为（30±12）min，第11组淋巴结清扫时间（8±3）min。共获取141枚第10组淋巴结，（3.8±2.4）枚/例，阳性淋巴结22枚，淋巴结阳性率为15.60%（22/141），第10组淋巴结转移率为18.75%（6/32）。共获取168枚第11组淋巴结，（4.0±3.6）枚/例，阳性淋巴结36枚，淋巴结阳性率为21.43%（36/168），第11组淋巴结转移率为25.00%（8/32）。32例患者肿瘤组织学分型：高分化8例，中分化腺癌14例，低分化腺癌 10例。pTNM分期：ⅡB期17例、ⅢA期15例。32例患者术后住院时间为（12.9±1.8）d。32例患者术后均无脾脏移位、脾扭转、脾梗死、吻合口漏、胰液漏或死亡等严重并发症发生，1例出现淋巴�Objective：To investigate the feasibility and safety of spleenpreserving No.10 and 11 lymph nodes dissection in the D2 radical gastrectomy for gastric cancer. Methods：The retrospective and descriptive study was conducted. The clinicopathological data of 32 patients with advanced proximal gastric carcinoma who were admitted to the Third Affiliated Hospital of Anhui Medical University from January 2013 to May 2016 were collected. All the patients underwent open D2 radical total gastrectomy and spleenpreserving No.10 and 11 lymph nodes dissection by the same operation team. Observation indicators included operation time, volume of intraoperative blood loss, time of No.10 and 11 lymph nodes dissection, number of lymph nodes dissection, number of positive lymph nodes, positive rate of lymph nodes, lymph node metastasis rate, histological classification, pTNM staging, duration of postoperative hospital stay, postoperative complications （splenic translocation, splenic torsion, splenic infarction, anastomotic leakage, pancreatic leakage and lymphorrhagia） and followup. The followup using outpatient examination and telephone interview was performed to detect the oncologic prognosis up to September 2016. Measurement data with normal distribution were represented as ±s. Count data were represented as a ratio. Results：Among the 32 patients, gastric body cancer and cardiac cancer were respectively detected in 12 and 20 patients, they received open radical total gastrectomy and spleenpreserving No.10 and 11 lymph nodes dissection. The operation time and volume of intraoperative blood loss were （242±34）minutes and （98±67）mL. Time of lymph nodes dissection, number of lymph nodes dissection, number of positive lymph nodes, positive rate of lymph nodes and lymph node metastasis rate were （30±12）minutes, 141 （3.8±2.4）, 22, 15.60%（22/141）, 18.75%（6/32） in No.10 lymph nodes and （8±3）minutes, 168 （4.0±3.6）, 36, 21.43%（36/168）, 25.00%（8/32） in No.11 lymph nodes, respectively. Hist

关 键 词：胃肿瘤 淋巴结清扫术 胃癌根治术 整体切除 

分 类 号：R735.2[医药卫生—肿瘤]