胃癌10和11组淋巴结转移及其清扫  

METASTASIS AND DISSECTION OF NO.10 OR 11 LYMPH NODES IN GASTRIC CARCINOMA

作　　者：高红桥[1] 刘玉村[1] 赵建勋[1] 陈国卫[1] 万远廉[1] 

机构地区：[1]北京大学第一医院外科,100034

出　　处：《中国现代医学杂志》2003年第11期57-60,共4页China Journal of Modern Medicine

摘　　要：目的 :研究胃癌脾门淋巴结 (No .10 )和脾动脉周围淋巴结 (No .11)转移规律 ,进一步探讨No .10和 11清扫的必要性和方法。方法 :1991年～ 2 0 0 0年 132例行全胃切除 ,D2以上淋巴结清扫的胃癌患者 ,回顾性研究临床病理资料 ,包括性别、年龄、肿瘤部位、大小、浸润深度、病理类型、其他淋巴结转移等对No .10和 11转移的影响 ,比较全胃切除和全胃联合脏器切除的并发症发生率。结果 :胃癌具有较高的No .10或 11淋巴结转移率 (18.9% ) ,Logistic回归分析表明 ,胃癌部位、病理类型、浸润深度和大小弯淋巴结转移五项临床病理指标影响No .10和 11转移率。联合脏器切除的并发症发生率 (32 % )明显高于单纯全胃切除 (11.2 % ) ,联合胰体尾切除增加膈下脓肿发生率 ,而脾切除并不增加全胃切除的危险性。结论 :No .10和 11在胃癌有较高的转移率和特定的转移规律 ,预防性和治疗性的清扫实属必要 ,联合左侧胰体尾加脾切除增加手术危险性 ,应严格掌握的适应证。而保留胰腺 ,切除脾血管和脾清扫No .10和 11淋巴结合理可靠。Objective: To determine the principle of No. 10 or 11 lymph nodes metastasis, to clarify the necessary and method of lymphadenectomy in gastric cancer.Methods:This study retrospectively investigated 132 patients undergone curative total gastrectomy for gastric carcinoma from 1991 to 2000,analysed the clinicopathological factors which influenced the No. 10 or 11 lymph nodes metastasis, including sex, age, location of the primary tumor, tumor sizes, gross type, invading depth, microscopic classification and other lymph nodes metastasis. This study also compared the complication after TG and TG+PS. Result: Matastasis to No. 10 or 11 lymph nodes happened in 18.9% patients. Logistic regression analysis showed that the proximal gastric cancer( upper third tumor) or diffuse type cancer, the depth of tumor invasion extends beyond the serosa, signet-ring cell carcinoma, positive metastasis in No.3 or 4 lymph nodes were predictive factors for metastasis to No. 10 or 11 lymph nodes. Complications after TG+PS (32%)were more common than TG alone(11.2%), but further analysis showed that only TG combined with pancreatectomy increased the complication incidence rather than TG combined with splenectomy. Conclusion: Because of the high matastasis rate, it is absolutely necessary to remove No. 10 and 11 lymph nodes in gastric carcinoma for prevetion or treatmemt. According to the special principle of the matatasis, we should preserve the pancreas as far as possible when dissecting the lymph nodes around the splenic artery and splenic hilum unless the tumor infiltrates the viscus directly.

关 键 词：胃癌 淋巴结转移 全胃切除 联合脏器切除 

分 类 号：R735.2[医药卫生—肿瘤]