胃癌单个淋巴结转移规律及临床意义

目的分析胃癌淋巴结转移的规律以指导临床规范化治疗。方法对天津医科大学附属肿瘤医院1999年7月至2004年6月间经手术治疗、清扫淋巴结数大于或等于10枚、术后病理证实仅有1枚淋巴结转移的胃癌患者临床资料进行回顾性分析．并对淋巴结跳跃与非跳跃转移、横向与非横向转移患者的资料进行对比。结果全组65例患者共检出淋巴结1415枚．平均21．8枚／例；单个淋巴结转移率的分布从多到少依次为N0．3（30．8％）、No．4（21．5％）、No．6（15．4％）、No．7和No．8（均为6．2％）、No．1和No．2及N0．5（均为4．6％）、No．12（3．1％）和No．14及No．16（均为1．5％）；其中跳跃转移20．0％（13／65），横向转移42．2％（19／45）。单因素分析显示．淋巴结跳跃性转移仅与肿瘤大小有关（X2=4．447，P=0．035）：淋巴结横向转移与各临床病理因素均无关。但淋巴结跳跃与非跳跃转移、横向与非横向转移间患者的生存曲线差异有统计学意义（P=0．000．P=0．000）。结论胃癌淋巴结转移规律总体遵循由远及近的转移顺序．但跳跃转移和横向转移方式也占有一定比例．对于胃癌淋巴结跳跃转移和横向转移的高危患者．术中应加强相应区域淋巴结清扫以提高患者生存率。

Pattern of solitary lymph node metastasis in gastric cancer and its clinical significance

Objective To investigate the pattern of solitary lymph node metastasis in order to offer more suitable treatment for patients with gastric cancer.Methods Sixty-five patients received operation between July 1999 and June 2004 with only 1 metastatic lymph node identified by postoperative pathological examination were included in the study.Data were analyzed using the statistical software SPSS 13.0.Results Univariable analysis showed that only the tumor diameter differed significantly between patients with skipping metastatic(SM)lymph node and those without SM(X2=4.447,P=0.035).No clinicopathological factors showed statistically differences between patients with lymph node transverse metastasis(TM)and those without TM.However,both of two comparative groups showed statistically differences in long-term survival(P=0.000,P=0.000).Conclusions Most lymph node metastasis in gastric cancer follows the rule of"near-to-far",but some special metastasis patterns(SM,TM)are not rare.Proper lymph node dissection especially for patients with high risk should be performed to reduce tumor recurrence and improve long-time survival.