远端胃癌淋巴结转移规律与淋巴结清扫方式的探讨

目的 探讨远端胃癌的淋巴结转移规律和合理的淋巴结清扫方式.方法 回顾性分析2001年1月至2010年12月间福建省立医院接受根治性手术的545例远端1/3胃癌患者的临床资料.按不同浸润深度进行分层,分析各组淋巴结的转移率.结果 全组患者淋巴结转移率为38.2％（208/545）.黏膜癌的淋巴结转移率为2.0％（2/99）,且均局限于第1站淋巴结.黏膜下癌淋巴结转移率为18.9％（18/95）,明显高于黏膜癌（P＜0.01）;其中第2站淋巴结中No.7,8,9组转移率分别为5.3％（5/94）、3.2％（3/94）和1.1％（1/89）;此外,有3.2％（3/95）的患者出现除No.7,8,9组之外的第2站淋巴结转移,包括No.1,11p,No.12淋巴结.当肿瘤浸润至肌层或更深层时,淋巴结转移率显著升高（P＜0.01）.结论 对于远端1/3胃黏膜癌,D1清扫即可;对于浸润肌层或更深层的肿瘤,应行标准D2清扫;而对黏膜下癌,需要扩大D1＋清扫的范围.

Pattern of lymph node metastasis and extent of lymphadenectomy for distal gastric cancer

Objective To analyze lymph node （LN） metastasis patterns and determine the appropriate extent of LN dissection in distal-third gastric cancer.Methods Clinical data of 545 patients with distal third gastric cancer undergoing radical operation in the Fujian Provincial Hospital between 2001 and 2010 were analyzed retrospectively.The metastasis rate for each LN station was analyzed stratified by the depth of tumor invasion.Results The incidence of LN metastasis in this cohort was 38.2% （208/545）.LN metastasis rate in mucosal cancer was 2.0% （2/99） and involved LNs were limited to station 1 LN stations. LN metastasis rate in submucosal cancer was 18.9% （18/95）,significantly higher than that in mucosal cancer（P〈0.01 ）.The metastasis rates to groups No.7,8 and 9 in station 2 were 5.3%（5/94）,3.2%（3/94）,and 1.1%（1/89） respectively.In addition,3 cases （3.2%） had metastasis in station 2 outside the range of groups 7,8 and 9 including groups No.1,11p and 12.Gastric cancer invading the muscularis propria or deeper layers showed an significant increased rate of metastasis （P〈0.01）.Conclusion D1 dissection seems to be sufficient for mucosal cancer.Standard D2 dissection should be performed for cancers of the muscularis propria or deeper.For submucosal cancer,an extended D1＋ dissection is required for complete removal of metastatic nodes.