残胃癌的淋巴结转移规律与手术治疗

目的 探讨残胃癌吉转移规律及其合理的根治术式。方法 回顾性分析我院从１９７９年３月至１９９７年９月收治的６４例残胃癌患者的淋巴结转移规律、手术及其疗效。结果 本组残胃癌患者６４例,占同期手术病人的２．１％。其中包括治愈性切除者３０例,其淋巴结转移率分别为第１组５９．１％、２组３３．３％、３组８０．０％、４组４６．７％、７组２５．０％、８组３６．４％、９组４０．０％、１０组６０．０％、１１组７２．３     

胃癌淋巴结转移研究新进展

淋巴结转移是胃癌的一个重要的生物学特性 ,日本学者认为扩大淋巴结清扫可显著改善患者的预后 ,并把Ｄ2 根治术作为胃癌的标准术式。西方学者认为淋巴结清扫对改善预后并无帮助 ,它仅能用于判断预后[1] 。两种观点争论不休 ,大量临床资料证实大范围的淋巴结清扫的确在某种程度上能够改善患者的预后 ,但同时也增加了并发症和死亡率 ,所以如何在术前术中了解淋巴结的状态 ,指导手术范围 ,术后依据淋巴结病理结果判断预后 ,都是国内外学者孜孜不倦研究的课题。1　胃癌淋巴结转移规律胃的淋巴引流是从胃的初级淋巴结逐步流向中间淋巴结(包括第二…     

胃癌淋巴结转移规律的研究现状

本文综述了胃癌淋巴结转移规律的临床研究现状，分析了胃癌淋巴结的转移率与诸多因素的关系，包括肿瘤浸润深度、大体形态、大小、组织分型、肿瘤发生部位、患者年龄、性别等，探究了肿瘤的部位和转移淋巴结的组群分布关系。     

残胃癌的淋巴结转移特点及外科治疗

目的 探讨残胃癌的淋巴结转移特点及外科治疗效果.方法 回顾性分析1994年1月至2008年1月大连医科大学附属第一医院收治的42例残胃新生癌患者(研究组)和同期收治的56例胃上部癌患者(对照组)的临床资料.采用t检验、X2检验分析相关数据,Kaplan-Meier法和Log-rank检验分析两组患者的生存率及淋巴结转移率.结果 研究组和对照组患者的胃周围第1～3组淋巴结转移率相近,转移率为43%～61%,其差异无统计学意义(χ2=0.752,0.833,0.678,P>0.05);第7～9组淋巴结转移率分别为22%、18%、25%和46%、25%、30%,其差异有统计学意义(χ2=2.168,3.263,5.761,P<0.05);第10～14组淋巴结转移率分别为47%、36%、31%、20%、25%和33%、34%、19%、6%、0,其差异有统计学意义(χ2=3.225,1.883,3.945,4.137,6.823,P<0.05);第16组淋巴结转移率分别为0和23%;空肠系膜淋巴结转移率分别为27%和0.研究组和对照组患者总体5年累积生存率分别为38%和48%,两组比较差异有统计学意义(χ2=4.165,P<0.05).研究组和对照组根治度A、B患者的5年生存率分别为54%和57%,两者比较差异无统计学意义(χ2=0.622,P>0.05).结论 残胃癌有其独特的淋巴结转移规律;应采取积极的外科治疗,对于改善患者预后有积极的作用.     

残胃癌的淋巴结转移特点及外科治疗

Objective To explore the characteristics of lymph node metastasis in gastric stump cancer and the efficacy of surgical treatment. Methods The clinical data of 42 patients with gastric stump cancer (test group) and 56 patients with primary cancer in the upper stomach (control group) who were admitted to The First Affiliated Hospital of Dalian Medical University from January 1994 to January 2008 were retrospectively analyzed. All data were analyzed by t test and chi-square test. The survival of the patients and lymph node metastasis rate were analyzed using the Kaplan-Meier method and Log-rank test, respectively. Results The metastasis rates of lymph nodes 1-3 of the test group and control group were similar (43%-61%), with no significant difference between the 2 groups (χ2 = 0.752, 0. 833, 0. 678, P > 0. 05). The metastasis rates of lymph nodes 7-9 of the test group and control group were 22% , 18% , 25% and 46% , 25% , 30% , respectively, and this was signifi-cantly different between the 2 groups (χ2 = 2. 168, 3. 263, 5. 761, P < 0. 05). The metastasis rates of lymph nodes 10-14 were 47% , 36% , 31% , 20% and 25% in the test group, which were significantly higher than 33% , 34% , 19% , 6% and zero in the control group, respectively (χ2 =3.225, 1.883, 3.945, 4.137, 6.823, P <0.05). The metastasis rate of lymph node no. 16 was zero in the test group and 23% in the control group. The metastasis rate of jejunal mesenteric lymph nodes was 27% in the test group and zero in the control group. The accumulative 5-year survival rate of patients was 38% in the test group and 48% in the control group, and this was significantly different (χ2 =4. 165, P<0.05). The overall 5-year survival rate of patients with radical resection was not significantly different between degree A (54%) and B (57%) (χ2 = 0. 622, P > 0. 05). Conclusions Gastric stump cancer has a unique pattern in lymph node metastasis. Surgical resection is effective in improving the prognosis of patients with gastric stump cancer.     

残胃癌的淋巴结转移特点及外科治疗

Objective To explore the characteristics of lymph node metastasis in gastric stump cancer and the efficacy of surgical treatment. Methods The clinical data of 42 patients with gastric stump cancer (test group) and 56 patients with primary cancer in the upper stomach (control group) who were admitted to The First Affiliated Hospital of Dalian Medical University from January 1994 to January 2008 were retrospectively analyzed. All data were analyzed by t test and chi-square test. The survival of the patients and lymph node metastasis rate were analyzed using the Kaplan-Meier method and Log-rank test, respectively. Results The metastasis rates of lymph nodes 1-3 of the test group and control group were similar (43%-61%), with no significant difference between the 2 groups (χ2 = 0.752, 0. 833, 0. 678, P > 0. 05). The metastasis rates of lymph nodes 7-9 of the test group and control group were 22% , 18% , 25% and 46% , 25% , 30% , respectively, and this was signifi-cantly different between the 2 groups (χ2 = 2. 168, 3. 263, 5. 761, P < 0. 05). The metastasis rates of lymph nodes 10-14 were 47% , 36% , 31% , 20% and 25% in the test group, which were significantly higher than 33% , 34% , 19% , 6% and zero in the control group, respectively (χ2 =3.225, 1.883, 3.945, 4.137, 6.823, P <0.05). The metastasis rate of lymph node no. 16 was zero in the test group and 23% in the control group. The metastasis rate of jejunal mesenteric lymph nodes was 27% in the test group and zero in the control group. The accumulative 5-year survival rate of patients was 38% in the test group and 48% in the control group, and this was significantly different (χ2 =4. 165, P<0.05). The overall 5-year survival rate of patients with radical resection was not significantly different between degree A (54%) and B (57%) (χ2 = 0. 622, P > 0. 05). Conclusions Gastric stump cancer has a unique pattern in lymph node metastasis. Surgical resection is effective in improving the prognosis of patients with gastric stump cancer.     

胃癌淋巴结转移的临床病理研究

为探讨胃癌淋巴结转移与原发癌临床病理学特性的关系，给选择合理的淋巴结清除范围提供依据，作者统计分析了手术切除的１９２例胃癌标本，结果：本组胃癌的淋巴结转移率为６０．４％，转移度为２８．９％。     

胃癌淋巴结转移研究的进展与新规定

近年，胃癌外科治疗取得较大进步，这些成绩与其外科基础研究不断深入相伴而行，相辅相成。本文仅就目前胃癌淋巴结转移的数点研究，结合作者经验体会简述如下。胃癌部位划分与淋巴结站属的新规定过去，日本胃癌处理规约将胃分为3大部，其名称及代号为贲门部（C）、中部（M）、窦部（A），再分为5个区[1]。新规约改为上部（U）、中部（M）和下部（L），分为6个区，即①LMU/MUL/MLU/UML；②LD/L；③LM/M/ML；④MU/UM；⑤U；⑥E+。将“L”和“U”单独提出，各部区所属淋巴结亦有一定变动。将每区的D2清除术作为标准根治的清除术…     

根治性淋巴结清扫联合脾切除在残胃癌手术中的临床意义探究

目的阐明淋巴结清扫与脾切除在残胃癌手术中的重要性。方法远端残胃癌患者63例,行D_2行淋巴结切除23例,非D_2淋巴结切除40例,并行脾切除30例,未行脾切除33例。观察患者的术后总体生存率,分析残胃癌患者全胃切除术后临床病理特征、手术治疗和长期预后。结果D_2淋巴结清扫术和非D_2淋巴结清扫术切除淋巴结的平均数量分别为(16.5±1.5)枚和(7.7±1.4)枚,两者比较差异有统计学意义(P0.01);pT1/pT2肿瘤患者脾门区域无淋巴结转移,pT3/pT4肿瘤患者发生淋巴结转移4例;浸润深度为pT3/pT4肿瘤患者切脾组生存率高于保脾组(P0.01),而pT1/pT2肿瘤患者差异无统计学意义(P0.05);浸润深度为pT3/pT4肿瘤患者D_2淋巴清扫术组生存率高于非D_2组(P0.01),而pT1/pT2肿瘤患者则无明显差异(P0.05)。结论根治性淋巴结清扫与脾切除对晚期(pT3/pT4)残胃癌患者有益。     

胃癌淋巴结微转移的研究进展

淋巴结转移是胃癌的主要转移方式之一,影响患者的预后.在经常规病理检查其淋巴结为阴性的患者,术后仍有25%的肿瘤复发率,这就会影响患者的生存率,研究发现这与淋巴结微转移的存在柯密切关系.本文将就微转移的最新研究进展进行综述.     

Prognostic Significance of Level and Number of Lymph Node Metastases in Patients with Gastric Cancer

BACKGROUND: To present data that provide some insight into the appropriateness of a nodal grouping category and its relation to survival in patients with gastric cancer. METHODS: We reviewed data of 777 patients with advanced gastric cancer who had undergone curative gastrectomy to investigate the prognostic significance of level and number of lymph node metastases. RESULTS: The prognosis of patients with gastric cancer was well correlated with the level and number of lymph node metastases. Multivariate analysis indicated that the level and number of lymph node metastases were independent prognostic indicators. Moreover, the number of lymph node metastases was an independent prognostic factor in N1, N2, and N3 patients. The most statistically significant difference in disease-specific survival was observed at a threshold of 11 lymph node metastases, yielding a chi2 value of 42.88, a hazard ratio of 2.523, at a 95% confidence interval of 1.913, 3.329 (P < .0001) by Cox proportional hazard model. On the basis of this result, patients were divided into two groups as follows: marked lymph node metastasis group (number of positive nodes > or =11) and slight lymph node metastasis group (number of positive nodes < or =10). The prognosis of patients with marked lymph node metastasis was statistically significantly worse than that with slight lymph node metastasis in N1, N2, and N3 patients. CONCLUSIONS: Both level and number were indispensable for evaluating lymph node metastasis. Therefore, addition of the number of positive nodes to the N category defined by the Japanese Classification of Gastric Carcinoma may be a useful strategy in the N staging classification in gastric cancer.     

胃周阳性淋巴结数目是胃癌的一个预后指标

目的：研究胃周阳性淋巴结数目在胃癌预后中的意义。方法：将１２４例经组织学证实为淋巴结阳性者作为研究对象,分析胃周转移淋巴结数目与临床病理特征及生存率的关系。结果：１２４例胃周淋巴结阳性胃癌患者总的５年生存率为４８．３％,胃周阳性淋巴结超过６个的患者５年生存率明显下降（Ｐ＜０．０１）。与胃周阳性淋巴结≥７个的胃癌相比,阳性淋巴结数≤６个的胃癌常小于４ＣＣ（Ｐ＜０．００５）,多呈大体局限型（Ｐ＜０．０２５）,未侵及浆膜（Ｐ＜０．０１）,巨淋巴结转移多局限于胃周淋巴结（Ｐ＜０．００５）。结论：胃周阳性淋巴结数目与肿瘤进展和生存率相关,是淋巴结阳性胃癌的一个简便有用的预后指标。     

Artificial Neural Network for Prediction of Lymph Node Metastases in Gastric Cancer: A Phase II Diagnostic Study

Background Extension of lymphadenectomy in gastric cancer is controversial, and preoperative diagnosis of lymph node metastases (LNM) is difficult. Therefore, knowledge-based systems such as the Maruyama computer program (MCP) are being developed. MCP shows good prognostic value for the compartments; however, for different lymph node groups (LNG) there are a large number of false positives. The aim of this study was to evaluate artificial neural networks (ANN) for predicting LNM in patients with gastric cancer and to compare the predictive power with that of MCP.Methods A total of 135 consecutive patients who underwent D2 gastrectomy were included. We applied a single-layer perceptron to the data of 4302 patients from the National Cancer Center, Tokyo, and compared the results with those from the MCP.Results Prediction of N⁺ or N0 with ANN-1 (Borrmann classification, T category, and tumor size and location) had an accuracy of 79%. The predictive value for LNM in each of the LNG varied: ANN-1, 64% to 86%; MCP, 42% to 70%. We constructed another ANN by using the additional parameter of metastases in LNG 3 as an example of sentinel node. The accuracy of this ANN was 93%.Conclusions Using an ANN, LNM in each LNG can be accurately predicted. Additional knowledge about one lymph node improves the results.     

Solitary Lymph Node Metastasis in Gastric Cancer

The feasibility and diagnostic reliability of sentinel node (SN) biopsy for gastric cancer are still controversial. We studied the clinicopathological features and localization of solitary lymph node metastasis (SLM) in gastric cancer to provide useful information for use of the SN concept in gastric cancer. From 2000 to 2004, 3,267 patients with gastric cancer underwent D2 radical gastrectomy. The clinicopathological features of 195 patients with histologically proven SLM and the distribution of metastasized nodes were assessed. The incidence of SLM was 6.0% in all cases. Compared with the node-negative patients, significant differences were observed in age, tumor size, depth of invasion, and surgical type. The cumulative 5-year survival rate of patients with SLM was 80.5%, which was significantly lower than 90.2% for node-negative patients (P < 0.001). Of patients with SLM, 82.6% had it in the perigastric node area (N1), and the other 17.4% patients had skip metastasis in the N2-N3 nodes. Perigastric nodes were the most common first sites of drainage from the tumor, making them the main targets of the operative SN mapping procedure. Due to the higher than expected incidence of skip metastasis in gastric cancer, D2 lymphadenectomy should be performed until the reliability of SN navigation surgery is validated in multicenter prospective clinical trials.     

Impact of Splenectomy for Lymph Node Dissection on Long-Term Surgical Outcome in Gastric Cancer

Background:In the treatment of gastric cancer, splenectomy is performed for effective lymph node dissection around the splenic artery and splenic hilum. The purpose of this study was to clarify the long-term outcome of splenectomy in the treatment of gastric cancer.Methods: The effect of splenectomy on recurrence and prognosis was examined in a retrospective analysis of 665 patients who had undergone curative total gastrectomy for gastric carcinoma from 1987 to 1996. The risk factors associated with recurrence and prognosis were investigated by univariate and multivariate analysis.Results: The splenectomy group showed more advanced lesions and a higher recurrence rate than the spleen-preserved group. However, after adjusting for the TNM (tumor, node, metastasis) stage, there was no significant difference in recurrence rate and pattern between the two groups. Logistic regression analysis revealed that gross type, serosal invasion, and nodal metastasis were independent risk factors for recurrence while splenectomy was not. When comparing patients with the same TNM (tumor, node, metastasis) stages, no significant difference in the 5-year survival rates was apparent. Multivariate analysis demonstrated that age, serosal invasion, and nodal metastasis were independent prognostic factors whereas splenectomy was not.Conclusions: These data suggest that splenectomy for lymph node dissection in gastric cancer is not effective regarding long-term patient prognosis.     

计算机分析影响胃癌淋巴结转移的因素

目的:回顾性分析影响胃癌淋巴结转移的诸因素,为合理制定根治术式提供理论依据.方法:分析554例胃癌切除术患者的病史、手术记录和病理检测结果资料.应用BMDP软件包计算不同部位淋巴结转移者术后逐年生存率,采用单因素和Logistic回归多因素分析方法探讨胃癌临床病理特点与淋巴结转移的关系.结果:淋巴结转移者和无转移者5年生存率分别为31.04%和90.9%.单因素分析发现,大体类型、分化程度、浸润深度、原发部位及肿瘤大小均与淋巴结转移有关;多因素分析则发现肿瘤浸润深度及肿瘤大小为影响淋巴结转移的独立因素.结论:淋巴结转移是影响胃癌患者预后的重要因素,而胃癌的临床病理特点与淋巴结转移密切相关.     

Appropriate Gastric Resection with Lymph Node Dissection for Early Gastric Cancer

Background The extent of lymphadenectomy (limited vs. extended) and that of gastric resection (partial vs. total) remain controversial issues in the management of early gastric cancer (EGC). A multicentric study was performed to elucidate the appropriate gastric resection with lymph node dissection for early gastric cancer.Methods From 1979 to 1988, 332 patients with EGC underwent surgery in 23 French centers. Clinicopathological data, the extent of resection, and the number of lymph nodes retrieved were reviewed retrospectively and screened for prognostic effect. The mean follow-up for the 332 EGC patients was 80 months.Results Postoperative mortality was correlated to age (odds ratio [OR], 1.1) and extent of gastric resection (OR,10.3). Examination of survival data (excluding postoperative deaths) with univariate analysis and the Cox proportional hazards model showed that the independent factors for excellent prognosis included no lymphatic involvement (P = .005), 10 or more lymph nodes retrieved (P = .003), site of the tumor in the lower third of the stomach (P = .01), and mucosal lesions (P = .04). The extent of resection did not influence long-term survival.Conclusions Our results suggest that because of the associated good prognosis, the appropriate surgical treatment for EGC is partial gastrectomy with lymphadenectomy retrieving 10 or more lymph nodes.     

术前胃动脉化疗栓塞对胃癌淋巴结转移灶癌细胞凋亡的影响

目的探讨术前胃动脉化疗栓塞对胃癌淋巴结转移灶癌细胞凋亡的影响。方法对40例胃癌伴淋巴结转移患者行胃癌根治性切除术，根据术前是否行胃动脉化疗栓塞分为治疗组和对照组，各20例，采用免疫组化ABC法检测淋巴转移灶p53、bcl-2及CD95基因的表达，原位末端脱氧核苷转移酶标记法（TUNEL）检测细胞凋亡情况。结果治疗组淋巴转移灶p53和CD95表达较对照组明显增强（P〈0．05），并与细胞凋亡呈正相关，bcl-2表达则减低与细胞凋亡呈负相关。结论胃癌术前行胃动脉化疗栓塞，可能通过p53、bcl-2及CD95介导使转移淋巴结癌细胞凋亡增加，有助于提高根治性手术的治疗效果。     

食管癌手术中胃左动脉旁淋巴结切除的临床意义

目的探讨食管癌胃左动脉旁淋巴结转移的相关因素,评价胃左动脉切除在食管癌手术中的意义。方法186例食管癌患者行食管癌切除食管胃吻合术,手术切除肿瘤时常规连同胃左动脉及其周围所有淋巴结和脂肪组织切除,根据胃左动脉旁淋巴结是否转移将患者分为两组,胃左动脉旁淋巴结转移阳性组和胃左动脉旁淋巴结转移阴性组;采用t检验、卡方检验、秩和检验和log istic回归对组间可能影响胃左动脉旁淋巴结转移的因素进行分析。结果186例患者中胃左动脉旁淋巴结转移阳性33例(17.74%)。单因素分析显示肿瘤TNM分期、食管旁、贲门旁、隆突下淋巴结转移等因素与食管癌胃左动脉旁淋巴结转移相关(P<0.001,P=0.025,0.047,0.038);多因素分析显示仅肿瘤部位与食管、贲门癌胃左动脉旁淋巴结转移相关(P=0.002);胃左动脉旁淋巴结跳跃式转移发生率为78.79%(26/33)。结论食管癌胃左动脉旁淋巴结转移主要与肿瘤部位相关,食管癌术中应常规切除胃左动脉及周围组织。