胃癌根治术中肿大淋巴结的分析

目的　研究胃癌根治手术中肿大淋巴结实际转移状况并分析淋巴结切除范围与预后的关系。方法　查阅手术记录和术后病理报告并进行 5年随访。记录肿大淋巴结数 ,比较近端胃、远端胃和全胃切除术的淋巴结切除数目并分析其与预后的关系。结果　本组 15 5例胃癌标本中 ,共摘取淋巴结 3 3 0 5枚 (平均 2 1.3 2枚 /例 ) ;肿大淋巴结 10 3 7枚 (平均 6.69枚 /例 ) ;转移淋巴结 42 3枚 (平均 2 .73枚 /例 )。在 15 5例获 5年随访的患者中 ,行D2式手术 10 9例 ,D3式 46例 ,5年生存分别是 3 7例和 11例。结论　手术中肿大淋巴结不一定是转移淋巴结 ;胃癌根治术中淋巴结清扫范围不应盲目扩大 ,而应根据术中冰冻病检结果判断。

Analysis of swelling lymph nodes during radical surgery for gastric cancer

Objective To study metastasis of swelling lymph nodes during radical surgery for gastric cancer and to analyze the correlation between surgical extent and prognosis.Methods Operative recordings and postoperative pathological reports were reviewed and a 5-year follow-up was performed.The swelling lymph nodes were recorded.The number of dissected lymph nodes in proximal gastrectomy was compared with that in distal gastrectomy and that in total gastrectomy.Results A total of 3 305 lymph nodes were obtained from 155 specimens (mean 21.32).There were a total of 1 037 swelling lymph nodes (mean 6.69).There were a total of 423 metastatical lymph nodes (mean 2.73).During a follow-up for 155 cases of gastric cancer,109 cases were subjected to D2 operation and 46 cases D3 operation with the 5-year survival being of 37 cases and 11 cases respectively.Conclusion The swelling lymph nodes in operation are not always metastasical lymph nodes.The extent of lymph node in dissection for gastric cancer is decided according to the results of frozen sections.