胃癌淋巴管的形态计量学研究

目的 研究胃癌淋巴管的形态学特征及其与淋巴结转移的关系。方法 采用D2 40免疫组化染色检测70例胃癌中心区、癌旁区、正常区内的淋巴管，分析淋巴管的形态学特征与淋巴结转移的关系。结果 胃癌癌旁区淋巴管密度(41.32±15.62)个、总面积(33 139.08±19 352.37)μm2、平均面积(802.12±728.09)μm2、平均周径(132.35±65.76)μm；正常区淋巴管密度(30.06±11.86)个、总面积(45 424.65±33 824.64 )μm2、平均面积(1 511.28±1 301.21)μm2、平均周径(196.19±103.72)μm，差异均有统计学意义（P分别为0.000、0.009、0.000、0.000）。 淋巴结转移组胃癌癌旁区淋巴管密度(43.67±16.42)个、总面积(35 866.71±19 678.53)μm2、总周径(5 851.28±1 897.13)μm、平均面积(1 050.31±765.47)μm2、平均周径(161.90±77.13)μm，无淋巴结转移组胃癌癌旁区的密度(33.38±9.02)个、总面积(23 933.34±15 405.2)μm2、总周径(4 173.56±2 028.18)μm、平均面积(723.76±534.75)μm2、平均周径(123.01±60.88)μm，差异均有统计学意义（P分别为0.019、0.029、0.003、0.000、0.000）；以胃癌癌旁区淋巴管侵犯预测淋巴结转移与病理检查的检出率差异无统计学意义(P=0.125)，且吻合度强（κ=0.822>0.7，P=0.000）。结论 胃癌淋巴管新生存在于癌旁区，新生淋巴管管腔小；胃癌细胞可能是通过破坏癌旁区淋巴管进入淋巴循环而形成淋巴结转移；癌旁区淋巴管侵犯及淋巴管密度与淋巴结转移有关，有望成为预测淋巴结转移及决定手术方式的重要因子。

Morphological Quantitative Analysis of Lymph Vessel in Gastric Carcinoma

Objective 　To study the characteristics of lymph vessel in gast ric cancer and it s relationship with lymph node metastasis (LM) . Methods 　Lymph vessel in normal , peripheral , cent ral region of 70 primary human gast ric cancer were investigated by IHC staining for D2240. The relation between lymph vessel density (LVD) , lymph vessel mean area (LVMA) , lymph vessel mean diameter (LVMD) , lymph vessel invasion (LVI) and LM were analysed. Results 　Compared with the normal region of gast ric canc2 er , the LVD of peripheral region of gast ric cancer is significantly high (41. 32 ±15. 62 vs 30. 06 ±11. 86 , P = 0. 000 ) ,and there was a significant decrease in LVMA (802. 12 ±728. 09μm2 vs 1511. 28 ±1301. 21 μm2 , P = 0. 000) and LVMD (132. 35 ±65. 76μm vs 196. 19 ±103. 72μm , P = 0. 000) . The LVD (43. 67 ±16. 42 vs 33. 38 ±9. 02 , P = 0. 019) , total area (35866. 71 ±19678. 53μm2 vs 23933. 34 ±15405. 2μm2 , P = 0. 029 ) , total perimeter (5851. 28 ±1897. 13μm vs 4173. 56 ±2028. 18μm , P = 0. 003) , mean area (1050. 31 ±765. 47μm2 vs 723. 76 ±534. 75μm2 , P = 0. 000) , mean perimeter (161. 90 ±77. 13μm vs 123. 01 ±60. 88μm , P = 0. 000) of lymphatics in peripheral region of gast ric cancer with LM was signifi2 cantly increased than that of gast ric cancer without LM. The prediction of LM for gast ric cancer by LVI is in common with routine pathology ( P = 0. 125 ,κ= 0. 822 > 0. 7 , P = 0. 000) . Conclusion 　Lymphangio2 genesis exist s in peripheral region of gast ric cancer , and the lumina of newly formed lymphatics are much small , therefore the lymphocinesia of that region is inadequate. Malignent cells may penet rate the lym2 phatics and get into lymphocinesia via dest royed part s of endothelium in peripheral region of gast ric carci2 noma. Increased LVD and LVI were significantly associated with LM , and may play an important role in detecting LM in gast ric cancer and the decision making process for additional surgery.