进展期胃癌淋巴结转移的特点及临床意义

目的 探讨胃癌淋巴结(LN)转移的规律,指导胃癌LN廓清手术治疗。方法 回顾分析我院近5年来D_2或>D_2手术并有完整记录的298例进展期胃癌患者的临床资料,统计胃癌各组LN的转移情况。结果 术中LN肉眼检查与实际病理检查有一定的误差。D_2手术时,只要把No.12LN包括在内,部分LN归属哪一组,并不影响肿瘤的治疗和预后。在各组LN中,No.3、No.7、No.8、No.9 LN转移率最高,而No.13、No.17、No.18 LN对于不同部位的胃癌转移机会均很少,不同部位的胃癌No.3、No.4、No.7、No.8、No.9、No.11、No.16 LN转移机会大致相同。胃癌的LN跳跃式转移见于No.16 LN,而第3站的LN较为少见。探查时若无No.12 LN转移,No.13 LN病理检查均未见转移,可不必清扫。组织学类型分化低的胃癌其第3、4站LN转移相对少见,这可能与分化低的肿瘤易引起远处转移,而使患者失去根治手术的机会有关。结论 掌握胃癌LN的转移规律,对胃癌LN的廓清手术具有重要意义。

Regularity and clinicaal significance of lymph node metastasis in gastric cancer

Objective To investigate the regularity of lymph node(LN) metastasis in gastric cancer in order to guide lymphadenectomy. Methods Three hundred patients with advanced gastric cancer received radical resection with D2 or > D2 lymphadenectomy in our hospital during the recent 5 years. Detailed clinicopathological data were analyzed and regularity of lymph node metastasis was generalized. Results There was an error in distinguishing lymph node metastasis between mocrographic and pathological examination. As for curative D2 resection, No. 12 lymphadenectomy was more important than other nodes grouping because of their adhesion and amalgamation and no effect on prognosis. The incidences of No. 3, No. 7, No. 8, No. 9 LN metastasis were high, while those of No. 13, No. 17, No. 18 LN were low, and those of No. 3, No. 4, No. 7, No. 8, No. 9, No. 11, No. 16 LN metastasis were identical despite tumor location. Skipping metastasis was usually found in No. 16 LN, but rarely in the third-echelon lymph nodes. If No. 12 LN was found to have no metastasis during operation, it is unnecessary to resect No. 13 LN because of its rare mtetastasis. The incidences of the third or fouth-echelon lymph nodes metastasis were low even in some poorly-differentiated tumors with wide or distant metastasis because of rare radical resection. Conclusion The metastasis of lymph node in gastric cancer has certain regularity, which can provide a significant guidance for lymphadenectomy.