腹腔镜下淋巴结清扫对进展期胃癌根治度的影响

目的 研究腹腔镜下行进展期胃癌根治术时,淋巴结清扫达到胃癌根治度的程度及可能存在的优劣.方法 选择病灶位于胃下1/3的进展期患者共65例,胄中1/3病例3例,随机分为实验组(n=33)和对照组(n:35)分别行腹腔镜和开腹胃癌根治术(D2).观察其淋巴清扫数目、阳性淋巴结数以及阳性淋巴结切缘肿瘤细胞病理改变等情况,进行统汁学处理.结果 实验组(腹腔镜胃癌根治术组)平均清扫淋巴结(D)20.79±5.21枚,阳性淋巴结(N)10.09±5.30枚.对照组(JF腹胃癌根治术组)平均清扫淋巴结(D)21.20±5.04枚,阳性淋巴结(N)9.63±4.64枚,两种因素差异均无统计意义(P>0.05).实验组淋巴结切缘癌细胞阳性6枚,对照组为14枚,无显著差异(Jp>0.05).而两组切缘癌细胞阳性淋巴结电镜下观察有明显不同,实验组可见癌细胞出现崩解、坏死,对照组癌细胞仍具有细胞的形态结构.结论 腹腔镜下进展期胃癌淋巴结清扫可达到进展期胃癌根治术(D2)的要求,根治度A级(D>N),与开腹手术无显著差异.而清扫阳性淋巴结切缘的处理效果则优于传统手术.

Effect of laparoscopic lymph node dissection on the radical degrees of advanced gastric carcinoma

Objective To clarify weather or not lymph node dissection can achieve the requests of gastric carcinoma radical degrees under laparoscopic operation for advanced gastric careinoma. Methods Sixty-five cases of advanced gastric carcinoma with under 1/3 stomach lesions and three cases with middle 1/3 stomach lesions. were randomly divided into tow groups: assisted laparoseopic group(n=33)and conventional gastric carcinoma D2 radical surgery group(n=35).The number of lymph node dissection, and the incidence of positive lymph nodes oecnred in damaged capsule. the margin necrosis analyzed. Results The average lymph node dissection of the laparoscopic group were 20.79±5.21 were ohscrved. the positive oases were 9.63±4.64.The average lymph nnde dissection of the control group were 21.20±5.04.the positivecases were 9.63±4.64. The two groups had no significant difference f (P>0.05)1. Positive-margin lymph node in the control gmup was 6 and 14 in the experimenl group ( P>0.05). The experlment gnmp margin appeared necrosis under eletronic microseope and the control group appeared degeneratinn. Conclusions Laparoscopic advanced gastric carcinoma lymph node dissectinn can D2 radical of advanced gastriC carcinoma demands(D>N), have significant difference with conventional surgery. Positive lymph node dissection margin of treatment is better than traditional surgery.