食管胃结合部腺癌的临床病理结果与淋巴结转移规律的研究  

Clinicopathologic findings and lymph node metastasis of adenocarcinoma of the esophagogastric junction

作　　者：姚骏鹏 董剑宏[2] 张万红[2] Yao Junpeng;Dong Jianhong;Zhang Wanhong(The Second Clinical Medical College of Shanxi Medical Univrsity,Taiyuan 030001,China;Department of Diagestive Minimally Invasive Surgery,Shanxi Tumor Hospital Affiliated to Shanxi Medical University,Taiyuan 030013,China)

机构地区：[1]山西医科大学第二临床医学院,太原030001 [2]山西医科大学附属山西省肿瘤医院消化微创外科,太原030013

出　　处：《中华普通外科杂志》2020年第8期607-611,共5页Chinese Journal of General Surgery

摘　　要：目的通过分析食管胃结合部腺癌(AEG)患者的术后病理结果与淋巴结转移的关系,探讨不同Siewert分型AEG患者手术切除及淋巴结清扫范围对其预后的影响.方法回顾性分析2014年7月至2018年5月山西省肿瘤医院收治的350例AEG患者的临床资料,研究淋巴结转移与肿瘤直径、分化程度、浸润深度等临床病理特征之间的关系,探讨第三站淋巴结清扫在贲门癌根治术中的价值.采用Logistic回归模型分析淋巴结转移的危险因素.结果350例AEG患者共清扫淋巴结6718个,其中阳性淋巴结1613个,转移率为24.01%.SieweaⅠ型AEG淋巴结转移以胸部纵膈为主,腹腔中第1、2、3、7组淋巴结转移率分别为23.30%、20.16%、41.90%、20.87%,明显高于其他各组淋巴结;SiewenⅡ、Ⅲ型AEG淋巴结转移侧重于腹腔.研究结果显示:随肿瘤浸润深度的增加,周围淋巴结转移率增高,差异有统计学意义(P<0.01);低分化组和中高分化组的淋巴结转移率分别为83.1%和58.4%,差异有统计学意义(P<0.01);肿瘤瘤体直径≥4 cm时患者的淋巴结转移率明显增加,差异有统计学意义(P<0.05).第三站淋巴结转移率的高低与肿瘤的侵犯胃壁深度、肿瘤瘤体的最大径、肿瘤的分化程度相关.结论肿瘤瘤体最大径、浸润胃体深度及分化程度是影响AEG患者淋巴结转移的独立危险因素.对于AEGⅠ型患者在根治术中应彻底清扫纵膈及下段食管周围淋巴结,腹部需重点清扫第1、2、3和7组淋巴结,可根据探查有无肿大的淋巴结再决定是否清扫其他各组淋巴结;对于Ⅱ、Ⅲ型AEG患者,当肿瘤侵犯胃壁全层、最长直径≥4 cm,并且分化程度为低分化时推荐行保脾的全胃切除并行D2淋巴结清扫术.Objective By analyzing the relationship between postoperative pathology and lymph node metastasis of the adenocarcinoma of esophagogastric junction patients to explore the effecet of surgical resection and lymph node cleaning scope on prognosis in different Siewert type patients.Methods A retrospective analysis was made on 350 cases of esophageal gastric junction adenocarcinoma at Tumor Hospital of Shanxi Province from July 2014 to May 2018.Patients clinical data such as lymph node metastasis and tumor diameter,differentiation degree,infiltration depth were studied.The value of the third leg of lymph node cleaning in cardia cancer radical were discussed.Risk factors of lymph node metastasis were analyzed by Logistic regression model.Results A total of 6718 lymph nodes were dissected in 350 patients with adenocarcinoma of esophagogastric junction,including 1613 positive lymph nodes,with a metastasis rate of 24.01%.The metastatic rate of Siewert type I lymph nodes was 23.30%,20.16%,41.90%and 20.87%in the first,second,third and seventh groups,respectively,which was significantly higher than that of other groups.Siewert II and Il focus on the abdominal cavity.with the increase of tumor infilration depth,the rate of peripheral lymph node metastasis increased,and the difference was statistically significant(P<0.01).The rate of lymph node metastasis was 83.1%in the low-diferentiation group and 58.4%in the middle-high differentiation group,respectively(P<0.01).When the tumor diameter≥4 cm,,the rate of lymph node metastasis in the patients increased significantly,and the difference was statistically significant(P<0.05).The rate of lymph node metastasis at the third station was correlated with the depth of invasion of the gastric wall,the longest diameter of the tumor body,and the degree of differentiation of the tumor.Conclusions The longest diameter of tumor body,the depth of infiltration and the degree of differentiation are independent risk factors for lymph node metastasis in AEG patients.For patients with type AEG

关 键 词：胃肿瘤 食管胃结合处 淋巴转移 病理学 临床 

分 类 号：R735.2[医药卫生—肿瘤] R735.1[医药卫生—临床医学]