Siewert Ⅱ型食管胃结合部腺癌的幽门周围淋巴结清除的意义  

Risk factors of parapyloric lymph nodes metastasis in Siewert type Ⅱ esophagogastric junction adenocarcinoma

作　　者：李明 孟庆彬[2] 邵永胜[2] 李栋梁 冯燕[3] 吴文良[2] 卢昕[2] 黄洋[2] Li Ming;Meng Qingbin;Shao Yongsheng;Li Dongliang;Feng Yan;Wu Wenliang;Lu Xin;Huangyang(Department of Gastrointestinal Surgery,Xishui Country People＇s Hospital of Hubei Province,Xishui 438200,China)

机构地区：[1]浠水县人民医院胃肠外科,湖北黄冈438200 [2]武汉市第一医院胃肠外科 [3]武汉市第一医院病理科

出　　处：《腹部外科》2018年第4期238-240,244,共4页Journal of Abdominal Surgery

基　　金：湖北省自然科学基金(2016CFB595);湖北省卫生计生委科研基金(WJ2015MB137)

摘　　要：目的分析Siewert Ⅱ型食管胃结合部腺癌(adenocarcinoma of the esophagogastric junction,AEG)幽门周围淋巴结(Parapyloric lymph node,PLN)转移的状况及相关危险因素。方法 2013年1月至2017年12月共完成Siewert Ⅱ型AEG病例R0切除手术85例。记录每例手术标本的淋巴结数目,计算本组病例的淋巴结总数和平均值,计算PLN转移率,分析PLN转移的相关危险因素。结果 85例Siewert Ⅱ型AEG病例的手术标本共检出淋巴结4167枚(16～157枚),(49.02±16.24)枚/例。85例中,68例有淋巴结转移,总体淋巴结转移率为80.00%,PLN转移率为18.82%。PLN转移与性别、年龄、肿瘤分化程度及Laurén分型不相关(χ~2值分别为0.007、0.288、0.176、0.954,P值均>0.05),与肿瘤大小及侵犯深度(pT分期)相关(χ~2=17.358,P<0.001;χ~2=14.921,P=0.002)。结论 Siewert Ⅱ型AEG病例宜行全胃切除,尤其是T3、T4期或肿瘤直径≥4 cm病例必须行全胃切除术。Objective To investigate the risk factors of parapyloric lymph nodes metastasis in Siewert type Ⅱ esophagogastric junction adenocarcinoma.Methods The clinicopathological data of 85 patients with Siewert type Ⅱesophagogastric junction adenocarcinomas who underwent radical surgery during January 2013 to December 2017 were retrospectively analyzed.The number of lymph nodes in each case was recorded.The total and average number and the metastasis ratios were calculated.The risk factors were analyzed.Results 4 167 lymph nodes in 85 Siewert type Ⅱ esophagogastric junction adenocarcinomas were detected in surgical specimens and the average number was 49.02±16.24.68 in85 cases having lymph node metastasis and the overall lymph node and PLN metastasis rate was80.00% and 18.82% respectively.The PLN metastasis was not related to gender,age,tumor differentiation,type and Laurén type（P〉0.05）,and related to the tumor size and depth of invasion（χ~2=17.358,P〈0.001;χ~2=14.921,P=0.002）.Conclusions The total gastrotectomy should be performed in Siewert type Ⅱ esophagogastric junction adenocarcinomas,especially in cases of T3,T4 stage and the tumor diameter≥4 cm.

关 键 词：食管胃结合部腺癌 幽门周围淋巴结 胃切除术 淋巴结切除术 

分 类 号：R735.2[医药卫生—肿瘤]