胃窦癌肝十二指肠韧带淋巴结微转移与清扫

目的检测进展期胃窦癌肝十二指肠韧带淋巴结微转移状况,探讨进展期胃窦癌根治术肝十二指肠韧带淋巴结清扫的必要性。方法采用逆转录聚合酶链式反应(RT-PCR)技术,以细胞角蛋白20(CK20)mRNA为标志基因,对45例进展期胃窦癌患者的86枚肝十二指肠韧带淋巴结标本进行检测。结果45例进展期胃窦癌患者有23例出现肝十二指肠韧带淋巴结CK20阳性(51.11%),与常规病理检查相比,存在显著性差异(P<0.01);常规病理检查阴性的86枚淋巴结有46枚CK20阳性(53.49%),亦存在显著性差异(P<0.01)。肝十二指肠韧带淋巴结微转移与临床分期、浸润深度以及肿瘤分化程度显著相关。结论RT-PCR技术检测CK20 mRNA是诊断胃窦癌淋巴结微转移敏感而特异的方法,进展期胃窦癌根治术应包括肝十二指肠韧带淋巴结的清扫。

Micrometastasis and dissection of lymph node of hepatodudenal ligament in gastric antral cancer

Objective To detect the micrometastasis status and necessity of dissection of lymph nodes of hepatodudenal ligament in advanced gastric antral cancer. Methods Eighty-six lymph node samples of hepatodudenal ligament which were negative in routine pathological examinations were collected from 45 gastric antral cancer patients with radical dissection.The expressions of CK20 mRNA were detected for the existence of micrometastasis by RT-PCR. Results Micrometastasis was found in 46 out of 86 lymph nodes(53.49%) and 23 out of 45 patients(51.11%),significantly different from the routine pathological examinations(both P<0.01).Besides,micrometastasis was closely related to clinical stages,depth of infiltration and differentiation of gastric antral cancer. Conclusion CK20 mRNA expression detected by RT-PCR is a sensitive and specific method for detection of micrometastasis in gastric antral cancer.Lymph node dissection of hepatoduodenal ligament should be performed in radical operation in advanced gastric antral cancer.