近端胃癌191例手术范围的探讨

目的: 探讨近端胃癌合理的切除范围。方法: 分析191例近端胃腺癌根治手术临床资料,评价各组淋巴结清扫效能。结果: 淋巴结清扫效能指数从高至低依次是:贲门旁、胃左动脉旁、脾动脉旁、左肾静脉上旁和腹主动脉旁淋巴结,侵犯食管时,下段食管旁和膈上淋巴结清扫指数较高。结论: 淋巴结清扫范围应根据肿瘤部位来定,进展期近端胃癌应清扫腹主动脉旁淋巴结,肿瘤侵犯食管时应清扫低位食管旁和膈上淋巴结。

Surgical strategy for upper a third gastric cancer in 191 patients

Objective:To investigate the rational scope of resection in treatment of the upper third gastric cancer.Methods:The clinical data of 191 patients undergoing radical resection for upper third gastric adenocarcinoma were analyzed and the efficacy of lymphadenectomy for the groups of the lymph nodes were evaluated.Results:The index of efficacy was the highest for lymph node removal in the paracardial regions,followed by along the left gastric artery,along the pancreatic artery,along the left renal vein and along the abdominal aorta.Removal of the lateroaortic lymph node on the cranial side of the left renal vein had a relatively ligh efficacy index.In patients with the esophagus involved,the efficacy of lower paraesophageal and supraphrenic lymph node removal was high.Conclusions:The scope of lymphadenectomy should be tailored to tumor location.The lymphadenectomy might include the lateroaortic lymph nodes for advanced gastric cancer in the upper third of the stomach and the supradiaphragmatic and lower paraesophageal nodes for tumors extending to the esophagus.