Distal intramural spread in colorectal cancer: a reappraisal of the extent of distal clearance in fifty cases.

Fifty colorectal carcinomas were investigated to demonstrate distal intramural spread (DIS). In 17 cases (34%) a DIS ranging from 0.25 to 3.5 cm was present. DIS was positively correlated with stage C2 (p less than 0.01), lymph node metastasis (p less than 0.03) and infiltrative growth of the tumor (p less than 0.05). Our results show that DIS is a relatively frequent event but of limited extension. In fact, a distal clearance margin of 2 cm was considered safe for all patients but one C2 mucoid case. No pathologic feature can predict preoperatively the presence and extent of DIS.     

T1和T2期直肠癌淋巴结转移特点及预后

目的 探讨T1和T2期直肠癌淋巴结的转移特点及预后。方法 回顾性分析241例T1和T2期直肠癌的淋巴结转移特点,用X^2检验分析其相关因素,并对预后进行单因素及多因素分析。结果T1和T2期直肠癌行Mile＇s术132例,保肛术109例,淋巴结转移率为22．0％（53／241）,X^2。检验显示,肿瘤分化程度与淋巴结转移有关。5年生存率为91．5％。单因素分析显示,肿瘤组织学类型、浸润深度、分化程度、淋巴结转移、放疗与预后相关。多因素分析显示,肿瘤浸润深度为T1和T2期直肠癌患者预后的主要影响因素。结论 T1和T2期直肠癌均可发生淋巴结转移,肿瘤分化与淋巴结转移相关,根治性切除术预后较好,应作为首选的治疗方法。     

大切片上直肠癌远端壁内扩散的研究

目的 研究直肠癌远端壁内扩散的规律,为临床保肛手术提供依据。方法 收集广州中山医科大学肿瘤医院1996年8月－1997年10月间直肠癌手术标本98例,制成大切片,在显微镜下观察直肠癌的远端壁内扩散,运用等比回缩规律,得出活体情况下的远端壁内扩散长度。结果 98例标本中,48例发生远端壁内扩散,最短0．1cm,最长2．5cm,其中＜0．5cm者37例,≥0.5cm且＜1.0cm者6例,≥1.0cm者5例。从大切片上可以观察到肿瘤发生直接侵袭、神经侵袭、淋巴侵袭和血管侵袭。远端壁内扩散可同时或分别沿黏膜层、黏膜下层、内环肌层、外纵肌层和浆膜层进行。结论 直肠癌远壁内扩散范围大多在0．5cm以内,扩散≥1cm的很少。临床保肛手术远切缘≥3cm比较安全。     

直肠癌行侧方淋巴结清扫52例临床分析

目的探讨中下段直肠癌的侧方淋巴结转移情况。方法对1996年6月至2004年8月间行传统直肠癌根治术加盆腔侧方淋巴结清扫术的52例中下段直肠癌的临床资料进行回顾性分析。结果全组侧方淋巴结转移率9.62%(5/52)。有侧方淋巴结转移者多为浸润型和溃疡型,肿瘤较大占1/2肠周以上(直径>4 cm),肿瘤浸润全层并有局部外侵,分化差的低分化及黏液腺癌及年龄<50岁。结论应有选择性地对溃疡型或浸润型、肿瘤较大及分化差的中下段直肠癌患者行侧方淋巴结清扫术。     

病理特征在食管鳞癌放疗临床靶体积外放边界确定中的价值

目的 研究食管鳞癌镜下浸润转移特点及临床病理特征对其影响,为食管鳞癌临床靶体积(CTV)边界确定提供参考依据.方法 根据每个标本的收缩比计算食管组织体内每厘米长度对应的固定后长度并取材,观察64例标本肿瘤外纵向每厘米范围浸润转移情况.结果 浸润转移阳性率随着距肿瘤边缘距离增加而降低,近端和远端3 cm组出现浸润转移概率分别为4.8%和6.9%,4 cm组分别为3.6%和3.6%.肿瘤长度>5 cm、分化程度低、有淋巴结转移、T3期病例浸润转移发生率高(79.3%:45.7%、77.4%:45.5%、76.0%:51.2%、70.5%:40.0%,χ2=7.52、6.86、3.91、5.36,P=0.006、0.009、0.042、0.021).分化程度、肿瘤长度是影响食管鳞癌浸润转移的主要因素(χ2=0.19、4.82,P=0.020、0.017).结论 食管鳞癌精确放疗若要包括95%的浸润转移病灶CTV应在大体肿瘤体积(GTV)基础上纵向上放3 cm、下放4 cm,若要包括90%的浸润转移病灶则需在GTV基础上上、下均外放3 cm.同时要综合考虑病理特征对靶区范围的影响.

Abstract：

Objective To study the characteristics of microscopic spread of esophageal squamous-cell carcinoma (ESCC) and the influence of clinicopathological features on it to help define the clinical target volume (CTV) margin in radiotherapy.Methods Sixty-four surgical specimens of ESCC were observed for longitudinal microscopic spread per centimeter both proximally and distally from the tumor.The shrinkage ratio of each specimen was calculated and used for tissue incision.Results The further the distance beyond the tumor, the lower the incidence there was of microscopic spread.Positive rates of microscopic spread in group 3 cm of proximal and distal were 4.8% and 6.9%, respectively, and in group 4 cm were both 3.6%.Tumors longer than 5 cm in length,with poorer differentiation, lymph nodes metastasis and more aggressive phase had higher positive rates (79.3% vs 45.7%,77.4% vs 45.5%,76.0% vs 51.2%,70.5% vs 40.0%,χ2=7.52,6.86,3.91,5.36;P=0.006,0.009,0.042,0.021).Differentiation and tumor length were main factors contributing to microscopic spread (χ2=0.19,4.82;P=0.020,0.017).Conclusions To cover 95% of the microscopic spread,a margin of 3.0 cm proximal and 4.0 cm distal beyond gross tumor volume is needed and as to 90%, a margin of 3.0 cm both proximal and distal is needed.Moreover, the influence of pathological features should be taken into account.     

46例直肠癌远端系膜内扩散情况

背景与目的:全直肠系膜切除可能因为清除了直肠癌远端系膜内的转移灶而获得较低的局部复发率,但直肠癌的远端系膜扩散情况如何、应该切除多长系膜才足够等问题尚无定论.本研究的目的是探讨直肠癌远端系膜内扩散的情况,为根治术提供更充分的临床病理证据.方法:应大切片连续切片、HE染色方法观察46例直肠癌根治术后标本中肿瘤远端扩散的方式和距离,并用Logistic回归方法分析其与临床病理因素的关系.结果:远端肠壁内浸润的发生率为10.9%(5/46),最远距离1.5cm;远端系膜内扩散发生率为21.7%(10/46),最远距离为4cm;扩散的方式有淋巴结转移、孤立的癌结节、脉管和神经浸润.多因素分析显示TNM分期是远端扩散的唯-影响因素.结论:直肠癌远端系膜内扩散较常见,根治术时应切除不少于5 cm的远端直肠系膜.     

Value of MR imaging in the staging of rectal carcinoma]

Correlative studies of MRI and pathologic specimens were done in 35 patients with rectal cancer. The MR manifestations of the primary tumor and its invasion into the surrounding structures were investigated with reference to the staging of rectal cancer. Prone positioning and the procedure of hypotonic air-distension of rectum was the method of choice to depict the primary tumor and tumor invasion. The spin-echo (SE)pulse sequence with TR/TE: 500/32 ms (T1-weighted image) was selected to show the anatomical structures in the pelvis and tumor spread in the surrounding fatty space and lymph node metastasis. Owing to the reduced contrast between tumor invasion and fatty tissue and decreasing signal intensity on multi-echo T2-weighted images the long repetiting time (TR) pulse sequence could not provide significant contribution in tumor staging. The MR appearance of rectal carcinoma was categorized as polypoidnodular, cauliflowermassive and protuberant-ring types. Ulceration was often seen in the latter two types. Peripheral invasion often manifested as spotty-nodular, sawtoothed-wavy and tumefied shape with medium signal intensity on T1-weighted images. The presence of a lump of small nodes, round or oval nodules within 2 cm from the rectal wall or nodular mass in the perirectal fatty space could be considered as possible lymph node metastasis. Following the modified Dukes Staging System of rectal cancer proposed by Astler-Coller all patients were staged preoperatively and correlated with surgical specimens. The accuracy of staging was 74.3%, compatible with the results of studies published.     

口腔鳞癌颈部淋巴结隐匿性转移的临床病理学特点及其意义

目的:探讨口腔鳞癌颈部淋巴结隐匿性转移的临床病理学特点及其临床意义。方法:对168例口腔鳞癌未探及颈淋巴结转移的患者的临床病理学因素与颈淋巴结转移的关系进行回顾性研究,并依据临床触诊及影像学结果将淋巴结分为三组,并对比各组淋巴结转移与临床病理学特点的相关性。结果:cN0期口腔鳞癌患者颈部淋巴结隐匿性转移与年龄、原发灶的大小、病理分化及生长方式存在统计学差异（P＜0.05）;牙龈癌及颊黏膜癌原发肿瘤越大发生颈部淋巴结隐匿性转移的几率越高。临床影像学未探及肿大淋巴结组其淋巴结阳性率与原发肿瘤大小及肿瘤生长方式密切相关（P＜0.05）,影像学肿大淋巴结小于1 cm组其颈部淋巴结阳性率与原发肿瘤病理分化程度密切相关。结论:口腔鳞癌颈部淋巴结的隐匿性转移是影响患者预后的重要因素,因此,明确隐匿性转移的危险因素,对选择合理的治疗方案、判断疗效及评估预后有重要作用。     

Rate of detection of lymph node metastasis is correlated with the depth of submucosal invasion in early stage gastric carcinoma.

BACKGROUND: Gastric carcinoma invading the submucosa is often accompanied by lymph node metastasis. However, the relation between the depth of submucosal invasion and the status of metastasis has not been investigated. The objective of this study was to clarify the relation between lymph node status and the histologic features of gastric carcinoma invading the submucosa. METHODS: The histopathology of 118 patients who underwent gastrectomy and lymph node dissection for gastric carcinoma invading the submucosa was examined. These pT1 tumors with invasion of the submucosa were confirmed by histologic examination of the resected specimens. Tumor size, depth of submucosal invasion, histologic type, and macroscopic type were investigated in association with presence or absence of and anatomic level of lymph node metastasis. RESULTS: Among the 118 patients, 16 (14%) had lymph node metastasis, and the status of metastasis significantly correlated with tumor size and depth of submucosal invasion. The frequency of metastasis to perigastric lymph nodes and extragastric lymph nodes was 0% and 0% for < or =1-cm tumors, 5% and 1% for 1- to 4-cm tumors, and 46% and 15% for >4-cm tumors, respectively. There was no lymph from a node metastasis in tumors with less than 300 microm of submucosal invasion. The frequency of lymph node metastasis for tumors with 300-1000 microm and >1000 microm of submucosal invasion were 19% and 14%, respectively. CONCLUSIONS: Tumor size and depth of submucosal invasion serve as simple and useful indicators of lymph node metastasis in early stage gastric carcinoma. Optimal lymph node dissection levels are as follows: 1) local resection (D0) for lesions < or =1 cm, 2) limited lymph node dissection (D1) for 1- to 4-cm lesions, and 3) radical lymph node dissection (D2) for lesions >4 cm. When submucosal invasion of a locally resected tumor is more than 300 microm, additional gastrectomy and lymph node dissection are necessary.     

Basosquamous carcinoma: analysis of prognostic factors influencing recurrence

BACKGROUND: Basosquamous carcinoma is a rare malignancy, with features of both basal cell carcinoma and squamous cell carcinoma. Some authors believe that basosquamous carcinoma merely is a variant of basal cell carcinoma, whereas others have suggested that basosquamous carcinoma may behave more aggressively. To the authors' knowledge the largest published series to date, comprised of 35 cases, was reported >20 years ago. The authors reviewed their recent experience with basosquamous carcinoma to identify prognostic factors influencing recurrence. METHODS: The medical records of all patients with the diagnosis of basosquamous carcinoma treated at the University of Louisville-affiliated hospitals between 1985-1988 were reviewed by a senior pathologist. Prognostic factors were analyzed using Cox regression analysis and the log rank test. RESULTS: Thirty-one cases of basosquamous carcinoma were identified in 28 patients. The median age at diagnosis was 68 years (range, 10-94 years). The median follow-up was 60 months (range, 12-312 months). Seventy-five percent of cases were located on the face, neck, and scalp. One patient had regional lymph node metastasis synchronous with the primary tumor. Patterns of recurrence were: local recurrence only (five patients), local recurrence plus regional lymph nodes (three patients), and pulmonary plus regional lymph nodes (one patient). One patient died of pulmonary metastasis. Significant factors predictive of recurrence (P<0.01) were male gender, positive surgical resection margin, lymphatic invasion, and perineural invasion. Although tumor size was not a statistically significant factor overall (P = 0.076), the 3 patients with lymph node metastases had large tumors (measuring 2 cm, 5 cm, and 5 cm, respectively). CONCLUSIONS: Basosquamous carcinoma is an aggressive epithelial neoplasm with a propensity for local recurrence and potential for distant metastatic spread. This behavior differs substantially from basal cell carcinoma. Complete resection with negative surgical margins is essential. Long term follow-up for the detection of local recurrence and distant metastatic spread is recommended.     

胃食管结合部腺癌区域淋巴廓清的临床研究

目的  探讨胃型胃食管结合部腺癌淋巴清扫范围与淋巴结转移区域分布规律。 方法  分析2004年1月至2015年12月,山西省人民医院普外科收治的胃食管结合部癌患者肿瘤数据库,基于Nishi分型选取其中胃型胃食管结合部腺癌肿瘤,直径≤40 mm并R0切除患者相关肿瘤学数据勾勒胃型胃食管结合部腺癌淋巴高频转移站别区域图。 结果  纳入306例胃型胃食管结合部腺癌患者,结果显示：pT4期肿瘤占87％、pN阳性占778％、pTNM分期Ⅲ期占745％;肿瘤直径（2544±1803）mm;腹腔淋巴结转移高频区域依次是贲门左右侧（第1、2组）、小弯侧胃左血管周围（第3组）、胰腺上缘腹腔干（第9组）及其主干分支胃左动脉（第7组）、肝总动脉（第8a组）、脾动脉近端（第11p组）、肝动脉（第12a组）周围以及食管裂孔周围（第19、20组）;胃远端区域转移较为罕见。 结论  瘤体直径≤40 mm胃型胃食管结合部腺癌淋巴清扫区域应集中在贲门左右侧、小弯侧、胰腺上缘腹腔干及其主干分支以及食管裂孔周围,胃远端及大弯侧区域淋巴清扫外科获益价值存疑。     

Lymph node involvement by direct extension in adenoid cystic carcinoma. Absence of classic embolic lymph node metastasis.

Thirty-four cases of adenoid cyctic carcinoma seen at the University of Virginia Hospital from 1946 to 1974 were reviewed, with special emphasis on lymph node involvement by tumor. Lymph node involvement was found in three cases of primary tumors of the submaxillary gland, and all of the affected lymph nodes were in the immediate vicinity of the primary tumor. Two lymph nodes were involved in two of the cases, and one node was involved in the third case. In all of these lymph nodes, adenoid cystic carcinoma was present in the soft tissue surrounding the node, and the tumor extended into the node. No metastatic tumors were observed in 46 lymph nodes removed incidentally at the time of local excision of the primary tumors in 10 additional cases or in 212 lymph nodes examined after unilateral radical neck dissections in six other cases. Five autopsies in this series showed no lymph node metastases. In this series of cases adenoid cystic carcinoma only invades lymph nodes in the immediate vicinity of the primary tumor. When lymph node involvement does occur, it does not result from embolic lymph node metastasis; rather, a direct invasion of the lymph node from tumor in the perinodal soft tissue occurs. Obviously, this small study does not completely exclude the possibility of embolic metastasis; however, if it does occur, it must be extremely rare.     

非小细胞肺癌淋巴结转移规律分析

背景与目的:淋巴结转移是肺癌最常见的转移途径,影响分期和预后,胸内淋巴结(包括肺门和纵隔)转移是影响肺癌预后的重要因素之一。本研究旨在对非小细胞肺癌(non-small cell lung cancer,NSCLC)术后淋巴结转移特点进行分析,为手术选择淋巴结清扫范围提供参考依据。方法:205例NSCLC手术病例,比较胸内各组淋巴结转移情况,从肿瘤原发部位和肿瘤组织类型两方面比较各分组之间淋巴结转移率及跳跃性转移率的差异。结果:205例NSCLC术中共清扫胸内淋巴结977组共3 577枚,平均每例17.4枚。其中220组共508个淋巴结存在转移,有胸内淋巴结转移病例98例,转移率为47.8%。发生跳跃性转移35例,转移率为17.1%。第4、5、7、10、11组淋巴结转移频度较高。肺上叶癌比肺下(中)叶癌更容易发生跳跃性转移。腺癌的淋巴结转移率明显高于鳞癌。结论:NSCLC的淋巴结转移多数是按肺内淋巴结到肺门淋巴结再到纵隔淋巴结的顺序进行逐级转移,纵隔淋巴结的跳跃性转移比较常见。NSCLC的淋巴结转移特点与肿瘤的原发部位、肿瘤组织类型有密切关系。手术应根据淋巴结转移规律对胸内淋巴结进行系统性清扫,特别注意转移频率较高的第4、5、7、10、11组淋巴结。     

保留乳房手术在早期乳腺癌治疗中的应用

目的：研究规范病例的选择、手术的范围及术后辅助治疗的方式,使早期乳腺癌的保乳治疗取得良好的局部控制水平、生存率及生活质量。方法：1995年10月-2000年2月,对78例早期乳腺癌病例实施了保乳治疗。手术指征：肿瘤最大直径≥3cm,周围型肿块,年龄≤65岁,病人有保留乳房的意愿,乳房足够大,以保证术后有良好的外形。手术方式为肿块广泛切除加腋淋巴结清扫;肿块位于乳腺外上象限者,原发灶与腋窝行整块切除。术后常规行辅助放疗及化疗。结果：手术标本各个切缘的组织病理切片检查未发现肿瘤累及。13例为导管内癌,9例特殊型浸润性癌,56例为浸润性导管癌;8例患者腋淋巴结发现癌转移,中位淋巴结转移个数为3个（1-8）。中位随访时间22个月。尚无局部及区域复发的病例。有1例远处转移,转移部位是胸膜,手术至转移期间30个月。对40名保乳治疗满一年的病例行乳房外形的随访,两侧乳头水平高度相差＞3cm有7例（17.5%),两侧乳房下皱褶水平高度相差＞3cm有3例（7.5%),两侧乳头与胸骨中线距离相差＞1.5cm有2例（5%）。结论：规范的广泛切除、腋淋巴结清扫及术后辅助放疗是早期乳腺癌保乳治疗的关键措施,可使局部复发率降低;同时保乳治疗后大多数病例能够保持良好的乳房外形。     

Patterns of lateral pelvic lymph node metastases and micrometastases for patients with lower rectal cancer.

AIMS: We aimed at investigating the patterns of lymph node metastases and micrometastases in regions of lateral pelvic area, examining circumferential margin involvement and clarifying their prognostic significance. METHODS: Large tissue slice and tissue array were adopted in the study of 67 patients with AJCC stages I-III lower rectal cancer who underwent total mesorectal excision with systematic lateral pelvic dissection. The outcomes were followed. RESULTS: Altogether, 726 lateral lymph nodes were examined, with 32 and 38 were involved by tumor metastases and micrometastases, respectively. Fifty-eight (82.9%) of the involved lymph nodes were smaller than 5mm. Status of lateral nodes was related to that of mesorectal ones. Middle rectal root (45.5%), internal iliac (31.8%) and obturator (22.7%) regions were more likely to be involved by metastases. Patients with lateral metastases, similar to the group with micrometastases, suffered more recurrence and poorer survival when compared with the ones without metastases. The occurrence of circumferential margin involvement suggested poor prognosis and was related to lateral node status. CONCLUSIONS: In lateral pelvic area, the majority of lymph nodes harboring tumor were small and could easily be neglected by conventional examination. Incidence of lateral metastases differed among regions, thus more attention should be given to the clearance of the highly occurred areas. More extensive range of dissection and/or adjuvant therapy was recommended for patients with lateral node metastases, micrometastases and circumferential margin involvement, since they predisposed poor prognosis.     

直肠癌保肛手术的安全下切缘

目的探讨直肠癌保肛手术的安全下切缘.方法对1983年1月～1992年12月10年间完成的402例直肠癌保肛手术,按性别、年龄、Duke′s分期、细胞分化程度、病理类型、肿瘤占据肠周的周径、术式和手术下切缘等变量进行分组.回顾性分析了对局部复发,远处转移和1、3、5年生存率的影响.结果局部复发率23.9%.其影响因素有Duke′sB,C期(P＜0.01),肿瘤占据肠周径＞1/2(P＜0.01),细胞中分化(P＜0.01)和低分化(P＜0.05),溃疡型(P＜0.05)和浸润型(P＜0.01)肿瘤及下切缘距离(2～3cm)(P＜0.01).远处转移率为44.8%,影响因素有Duke′sB期(P＜0.01)和C期(P＜0.05),细胞中低分化(P＜0.05),肿瘤占据肠周径＞1/2(P＜0.05)及溃疡型肿瘤(P＜0.01).1、3、5年生存率为84.3%、78.4%和59.7%.下切缘距离仅对1年生存率有影响(P＜0.05),对3、5年生存率无影响(P＞0.05).肿瘤分期、细胞分化、大体类型、肿瘤大小对生存率均有影响.结论对于直肠癌保肛手术,传统的2～3cm的下切缘是不安全的.     

宫颈癌盆腔淋巴结转移相关因素分析

目的：探讨宫颈癌盆腔淋巴结转移相关因素。方法：回顾性分析634例广泛性子宫切除及盆腔淋巴结清扫术后宫颈癌患者的临床分期及病理资料。结果：盆腔淋巴结总转移率为18.76%（119/634）,年龄、临床分期、肿瘤浸润深度、肿瘤生长形态、肿瘤细胞分化程度与淋巴结转移显著相关。病理类型、病灶大小、术前放化疗与淋巴结转移无相关性。结论：年龄≤35岁,临床分期晚,肿瘤浸润≥1/2,溃疡型肿瘤,病理分化差均为宫颈癌淋巴转移高危因素。     

宫颈癌盆腔淋巴结转移相关因素分析

目的:探讨宫颈癌盆腔淋巴结转移相关因素。方法:回顾性分析634例广泛性子宫切除及盆腔淋巴结清扫术后宫颈癌患者的临床分期及病理资料。结果:盆腔淋巴结总转移率为18.76%(119/634),年龄、临床分期、肿瘤浸润深度、肿瘤生长形态、肿瘤细胞分化程度与淋巴结转移显著相关。病理类型、病灶大小、术前放化疗与淋巴结转移无相关性。结论:年龄≤35岁,临床分期晚,肿瘤浸润≥1/2,溃疡型肿瘤,病理分化差均为宫颈癌淋巴转移高危因素。     

胸中段食管鳞癌淋巴结转移度及合理清扫范围的临床研究

目的:本研究通过分析胸中段食管鳞癌淋巴结转移规律及淋巴结转移度对预后的影响,探讨合理的淋巴结清扫范围.方法:对129例经现代二野淋巴结清扫术的胸中段食管鳞癌患者的临床资料进行回顾性分析.结果:全组患者淋巴结转移率为56.6%,总淋巴结转移度(阳性淋巴结数/清扫淋巴结总数,LMR)为11.3%,上纵隔淋巴结转移率为43.4%.最常见的淋巴结受累区域为食管旁、右喉返神经旁、贲门及胃左血管旁、隆突下.影响淋巴结转移的主要因素为肿瘤浸润深度、分化程度及肿瘤长度.无淋巴结转移组、淋巴结转移度≤20%组和淋巴结转移度>20%组患者5年生存率分别为50.4%、31.0%和6.8%,结果差异有统计学意义(P=0.000).结论:淋巴结转移度是判断食管癌预后的一个重要因素,胸中段食管癌应该常规行包括双侧上纵隔的现代二野淋巴结清扫术.     

远端胃癌淋巴结转移规律及临床意义*

目的:探讨远端胃癌各组淋巴结转移的特点,指导远端胃癌根治手术中淋巴结清扫的范围。方法:回顾性分析2010年2 月至2014年9 月天津医科大学肿瘤医院远端胃癌患者773 例接受D 2（D 2 +）胃次全切除术的临床病理资料,分析其淋巴结转移特点。结果:773 例远端胃癌患者术后病理证实淋巴结转移为423 例（54.72%）,各组淋巴结中发生转移的患者所占比例由高至低依次为NO.6、NO.3、NO.4sb 、NO.5 组淋巴结。N 1 淋巴结转移率由高至低依次为NO.3、NO.6、NO.5、NO.4d 组淋巴结;N 2 淋巴结转移率由高至低依次为NO.8a 、NO.7、NO.1 组淋巴结。50.68% 的患者出现NO.8a 组淋巴结跳跃性转移。结论:远端胃癌根治性手术应注意NO.8a 淋巴结转移的可能性,必要时应适当扩大淋巴结的清扫范围。