残胃癌淋巴结转移的相关研究

目的探讨残胃癌淋巴结转移的特点,为残胃癌术中合理的淋巴结清扫提供依据。方法回顾性分析广西壮族自治区人民医院普外-儿外科2004年6月至2012年6月期间由同一手术者进行残胃癌根治术的22例患者的临床资料,并用等距随机抽样法随机抽取同期原发性胃癌患者50例作为对照,比较2组患者的临床病理资料及术中所清扫淋巴结的转移情况。结果与原发性胃癌患者相比,残胃癌患者联合脏器切除率较高〔54.55%（12/22）比14.00%（7/50）〕,差异有统计学意义（χ2=12.929,P=0.000）。在淋巴结转移方面,残胃癌患者淋巴结总转移阳性率明显高于原发性胃癌患者〔30.56%（103/337）比22.13%（208/940）〕,差异有统计学意义（χ2=9.583,P=0.002）;微转移方面,残胃癌患者淋巴结微转移阳性率高于原发性胃癌〔2.97%（10/337）比1.49%（14/940）〕,但差异无统计学意义（χ2=2.939,P=0.086）。残胃癌患者No.10淋巴结总转移阳性率较原发性胃癌患者高〔52.17%（12/23）比17.39%（4/23）〕,差异有统计学意义（χ2=6.133,P=0.013）;残胃癌患者No.10的12个转移淋巴结中有4个微转移,原发性胃癌中未检出微转移淋巴结。残胃癌空肠系膜淋巴结转移阳性率为35.71%（5/14）。结论残胃癌有其独特的淋巴结转移规律,术中应行D2淋巴结廓清术和空肠系膜淋巴结清扫术,同时应重点对No.10淋巴结进行清扫,必要时行联合脏器切除。

Research on Lymph Node Metastases of Gastric Stump Cancer

Objective To study the features of lymph node metastasis in gastric stump cancer（GSC） in order to provide the basis for the reasonable lymph node dissection in the GSC lymphadenectomy.Methods Twenty-two GSC patients accepted residual radical gastrectomy and 50 primary gastric cancer patients accepted distal D2 lymphadenectomy by the same surgeon from June 2004 to June 2012 at the department of general surgery-pediatric surgery of the People＇s Hospital of Guangxi Zhuang Autonomous Region were included in this retrospective study.And the clinicopathologic factors and lymph node metastasis were compared in two groups.Results The combined organ resection rate in the primary gastric cancer patients was significantly lower than that in the GSC patients（14.00%（7/50） versus 54.55%（12/22）,χ2=12.929,P=0.000）.In the lymph node metastasis,the total positive rate and No.10 positive rate of lymph node metastasis in the GSC patients were significantly higher than those in the primary gastric cancer patients？（30.56%（103/337） versus 22.13%（208/940）,χ2=9.583,P=0.002;52.17%（12/23） versus 17.39%（4/23）,χ2=6.133,P=0.013）.The positive rate of lympl node micrometastasis between the GSC patients and primary gastric cancer patients was no significant difference（2.97%（10/337） versus 1.49%（14/940）,χ2=2.939,P=0.086）.There was 4/12 lymph node micrometastasis in the GSC patients,which was 0/4 in the primary gastric cancer patients.The positive rate of the jejunal mesentery lymph node metastasis was 35.71%（5/14） in the GSC patients.Conclusions GSC has a unique pattern in lymph node metastasis.D2 dissection and jejunsl mesentery lymph node dissection should be performed for these patients,especially,on No.10 lymph nodes.If needed,en bloc resection with invaded adjacent organs should be considered.