进展期胃癌No．8p淋巴结清扫的可行性  

Feasibility of No.8p lymphadenectomy for the patients with advanced gastric cancer

作　　者：叶再生[1] 曾奕[1] 魏晟宏[1] 王益[1] 林振孟 林志涛 陈小玲[1] 陈路川[1] Ye Zaisheng;Zeng Yi;Wei Shenghong;Wang Yi;Lin Zhenmeng;Lin Zhitao;Chen Xiaoling;Chen Luchuan(Department of Gastrointestinal Surgery,Key Laboratory of Tumor Biological Treatment of Fujian Province,Fujian Cancer Hospital ＆ Affiliated Cancer Hospital,Fujian Medical University,Fuzhou 350014,China)

机构地区：[1]福建省肿瘤医院、福建省肿瘤生物治疗重点实验室、福建医科大学附属肿瘤医院胃肠肿瘤外科,350014

出　　处：《中华胃肠外科杂志》2018年第10期1129-1135,共7页Chinese Journal of Gastrointestinal Surgery

基　　金：福建省科技厅自然科学基金项目（2017Y0022）;福建医科大学启航基金项目（2017XQ1219）;福建省卫生厅青年课题（2014-2-8）

摘　　要：目的分析进展期胃癌患者No.8p组淋巴结清扫的可行性，并对其改善预后的价值进行初步探讨。方法收集2003年7月至2013年7月期间，福建省肿瘤医院胃肠外科收治行胃癌根治术加D2或D2以上淋巴结清扫（均行No.8淋巴结清扫）的1158例进展期胃癌患者临床资料进行回顾性队列研究。其中，2003年7月至2008年6月期间的343例患者均仅行No.8a淋巴结清扫（No.8a清扫组）；2008年7月至2013年7月期间的815例患者均行No.8a加8p淋巴结清扫（No.8a加No.8p清扫组）。No.8a清扫组清扫胰腺上缘淋巴结和肝总动脉前方淋巴结；No.8a加No.8p清扫组在No.8a清扫基础上，清扫肝总动脉和肝固有动脉后面及门静脉左侧淋巴结。分析No.8淋巴结（No.8a及No.8p）的转移度和转移率以及No.8a清扫和No.8a加No.8p清扫两组患者术中和术后情况，并用Kaplan-Meier方法和log-rank检验分析两组患者预后。结果1158例进展期胃癌患者中男849例，女309例，年龄17~83（58.5±11.7）岁。行根治性远端胃切除325例（28.1%），根治性全胃切除833例（71.9%）；全组患者均顺利完成手术，共清扫No.8a淋巴结2587枚，淋巴结转移率和转移度分别为20.6%（239/1158）和13.0%（336/2587）。其中No.8a加No.8p清扫组共清扫No.8p淋巴结2170枚，No.8p淋巴结转移率和转移度分别为10.9%（89/815）和7.2%（156/2170）。No.8a加No.8p清扫组手术时间长于No.8a清扫组[（180.2±40.3）min比（168.4±41.8）min]，差异有统计学意义（t=-4.627，P=0.000）。但No.8a清扫组与No.8a加No.8p清扫组在术中出血量[（222.8±92.8）ml比（215.6±91.1）ml]、腹腔引流量[术后1 d：（257.7±120.0）ml比（270.3±121.0）ml]、拔除胃管、腹腔管和鼻饲管时间[胃管：（2.1±0.9）d比（2.2±0.8）d；腹腔管：（6.8±1.1）d比（6.9±1.1）d；鼻饲管：（6.5±1.2）d比（6.4±1.1）d]、术后并发症发生率[19.8%（68/343）比16.0%（130/815）]以及术�ObjectiveTo analyze the feasibility of No.8p lymphadenectomy for the patients with advanced gastric cancer and to preliminaryly explore its value in improving prognosis.MethodsClinical data of 1158 patients with advanced gastric cancer undergoing radical gastrectomy plus D2 or above D2 lymphadenectomy （No.8 lymphadenectomy） from July 2003 to July 2013 at Department of Gastrointestinal Surgery, Fujian Cancer Hospital were collected. A retrospective cohort study was carried out. Among 1158 patients, 343 patients from July 2003 to June 2008 only received No.8a lymph node dissection （No.8a group） , and 815 patients from July 2008 to July 2013 received No.8a＋No.8p lymph node dissection （No.8a＋No.8p group） . Patients in No.8a group received the dissection of the lymph nodes in the upper margin of the pancreas and the front of total hepatic artery, and those in No.8a＋No.8p group, on the basis of No.8a group, received the dissection of lymph nodes in the common hepatic artery and the left lymph nodes behind the hepatic artery and the portal vein. The metastasis degree and metastasis rate of lymph node （No.8a and No.8p） , as well as intraoperative and postoperative presentations in both groups were investigated. The prognosis of two groups were analyzed with Kaplan-Meier method and Log-rank test.ResultsAmong 1158 patients with advanced gastric cancer, 849 were males and 309 were females with aged 17 to 83 （58.5 ±11.7） years. Radical distal gastrectomy was performed in 325 cases （28.1%） and radical total gastrectomy in 833 cases （71.9%） . All the patients completed operations successfully. A total of 2587 No.8a lymph nodes were removed, and the lymph node metastasis rate and metastasis degree of No.8a were 20.6% （239/1158） and 13.0% （336/2587） , respectively. A total of 2170 No.8p lymph nodes were removed, and the lymph node metastasis rate and metastasis degree of No.8p were 10.9% （89/815） and 7.2% （156/2170） , respectively. The operation time of the No.8a＋No.8p group w

关 键 词：胃肿瘤 淋巴结切除术 预后 

分 类 号：R735.2[医药卫生—肿瘤]