不同浆膜反应类型胃癌淋巴结转移特点及其对实施合理根治术的指导意义

目的 分析不同浆膜反应类型胃癌淋巴结转移的特点,探讨其对实施合理根治术的指导意义.方法 收集73例因胃癌行全胃切除术患者的临床病理资料,按照浆膜反应类型分为正常型和反应型、结节型、腱状型和多彩弥漫型3组.比较3组间的淋巴结转移情况.结果 73例患者中,有61例出现淋巴结转移,转移率为83.6%.全组共切除2137枚淋巴结,其中有癌转移的淋巴结762枚,转移度为35.7%.正常型和反应型转移度为5.3%,结节型转移度为37.1%,腱状型和多彩弥漫型转移度为50.0%,差异有统计学意义(P<0.01).按照淋巴结分组分层,绝大多数淋巴结分组中不同浆膜反应类型患者淋巴结转移率差异也有统计学意义(P<0.01).结论 在胃癌浆膜分型中,正常型和反应型淋巴结转移度最低,结节型居中,腱状型和多彩弥漫型转移度最高.行胃癌切除术时,可根据浆膜反应类型判断淋巴结的转移程度,选择合理的术式.

Relationship between serosul invasion types and lymph node metastasis after total gastrectomy in gastric cancer and its significance in selection of rational dissection

Objective To evaluate the relationship between serosal invasion types and lymph node metastasis after total gastrectomy in gastric cancer patients, and explore its significance in planning practice rational dissection based on the serosa types of gastric cancer during surgery. Methods A total of 73 gastric cancer patients ,who underwent total gastrectomy and lymph node dissection ,were included in this study, and their clinicopathological data were analyzed. The serosa of gastric cancer was divided into five types: normal, reactive, nodular, tendonoid, and color-diffused, then they were combined into 3 groups: group 1: normal and reactive, group 2: nodular ( including protruding nodular and flat nodular), and group 3: tendonoid and color-diffused. The lymph node metastasis ratios in the 3 groups were compared. The lymph nodes in each of the 3 groups were divided into 16 subgroups and the lymph node metastasis ratios of each subgroup in the 3 groups were compared and analyzed. Results The lymph node metastasis ratio of the gastric cancer with normal and reactive type serosa was 5.3% (26/492), the nodular was 37.1% (250/ 673), the tendonoid and color-diffused was 50.0% (486/972). The lymph node metastasis ratio of normal and reactive type groups was the lowest, that of the tendonoid and color-diffused groups was the highest, and the nodular type in between, showing a statistically significant difference (P < 0.01 ). The results of comparing the lymph node metastasis ratios from the 1 st to 16th subgroup in the 3 groups showed the same trend ( P < 0.05). Conclusion Among all serosa types of gastric cancer, the lymph node metastasis ratio of the tendonoid and color-diffused is the highest, the normal and reactive type is the lowest, and the nodular in between. The extent of rational dissection should be carried out on the basis of serosa types of gastric cancer during surgery. An extended dissection including D2 and D3 lymphadenectomy should be performed for the patients with tendonoid and color-diffused serosa, a rational decreased operation including D1 ～ D1 <'+> lymphadenectomy should be performed for those with a normal and reactive type serosa, and for the patients with nodular type serosa, we suggest performing standard D2 dissection.