早期胃癌淋巴结转移与病理特征相关性分析及手术方式选择

目的探讨影响早期胃癌（EGC）淋巴结转移的相关病理学因素,为EGC的手术方式选择提供参考。方法回顾性分析228例早期胃癌患者的临床病理特征及淋巴结转移情况,分析早期胃癌的大小、原发部位、大体分型、组织学分型、侵润深度及分化程度等与淋巴结转移的相关性以及手术方式的选择。结果 228例EGC患者中出现淋巴结转移31例（13.6%）,其中粘膜内癌10例（7.9%）,粘膜下癌21例（20.6%）。单因素分析发现EGC淋巴结转移与肿瘤大小、肿瘤侵润深度及分化程度相关（P〈0.01）,而与肿瘤的大体分型、组织学类型、肿瘤部位无关（P〉0.05）。多因素分析发现肿瘤直径大于2 cm、粘膜下癌及分化程度低是EGC淋巴结转移的独立危险因素。对于肿瘤直径小于2 cm、分化程度较高的粘膜内癌并无淋巴结转移的EGC,建议行内镜下粘膜切除术（EMR）或内镜粘膜下剥离术（ESD）治疗。结论肿瘤直径大于2 cm、粘膜下癌及分化程度低是EGC淋巴结转移的独立危险因素,淋巴结转移影响了早期胃癌手术方式。

Aanalysis on correlation between pathologic characteristics and lymph hode metastasis in early gastric cancer and selection of operation style

Objective To explore the correlated pathological factors influencing the lymph node metastasis of early gastric cancer（EGC） and to provide references for the selection of operation styles.Methods The clinical pathologic characteristics and lymph node metastasis condition of 228 patients with EGC were retrospectively analyzed.The relationship between clinical pathologic characteristics including tumor size,primary locus,general typing,histology typing,infiltrate degree,differentiate degree with lymph node metastasis were analyzed.The operation styles of EGC were selected.Results Lymph node metastasis was detected in 31 out of all 288 patients（13.6%） including 10 with mucous cancer（7.9%） and 21 with sub-mucous cancer（20.6%）.Lymph node metastasis of EGC was correlated with tumor size,infiltrate degree and differentiate degree based on the results of single factor analysis（P0.01）,however,it was not associated with primary locus,general typing or histology typing（P0.05）.According to the results of multiple factor analysis,tumor diameter being smaller than 2 cm,sub-mucous cancer and low differentiate degree were the independent risk factors for lymph node metastasis of EGC.The endoscopic mucosal resection（EMR） or endoscopic submucosal dissection（ESD） was advised for the EGC which having mucous cancer with high differentiate degree and non-lymph node metastasis as well as tumor diameter being smaller than 2 cm.Conclusion Tumor diameter being smaller than 2 cm,sub-mucous cancer and low differentiate degree are the independent risk factors for lymph node metastasis of EGC.The lymph node metastasis of EGC influences the selection of operation styles.