胃癌淋巴转移规律与淋巴结清扫范围的分析(附326例报告)

目的 探讨胃癌淋巴结转称规律和胃癌根治术的淋巴清扫范围。方法 １９９０年～１９９９年行Ｄ２、Ｄ３、Ｄ３淋巴结廓清术加腹主动脉旁淋巴结廓汪术（Ｄ３加ＰＡＬ）的胃癌患者３２６例,对期临床资料进行回顾性分析。结果 本组总的淋巴结转移率６９．９％,早期与进展期胃癌淋巴结转移率分别为１５．４％和７７．４％。肿瘤浸润深度达Ｔ１的患者,淋巴结转移主要局限于Ｎ１;达Ｔ２的患者淋巴结转移至Ｎ３、Ｔ４的ＫＫＨＮＦＴＪ

Lymph node metastasis and the extent of lymph node dissection for gastric cancer: report of 326 cases

Objective To investigate the pattern of lymph node metastasis and the extent of lymph node dissection for gastric cancer. ]Methods 326 patients with gastric cancer admitted from 1990 to 1999 were analyzed retrospectively after D 2, D 3 or D 3 plus para aortic lymphadenectomy (D 3 PAL). Results The total incidence of lymph node metastasis was 69 9%; node involvement was 15 4% and 77 4% respectively for early gastric cancer and advanced gastric cancer. Depth of invasion, tumor size and histology affected lymph node metastasis significantly ( P <0 05). For T 1 patients, node involvement was mainly confined to N 1 and one patient had N 2 metastasis; 8 1% of T 2 patients and 28 7% of T 3, T 4 patients had N 3, M 1 lymph node metastasis. Among 107 patients who received D 3 PAL, 16a2b1 lymph node metastasis was found in 15 0%. The patients who had 16a2b1 node involvement were all suffered from advanced gastric cancer and N 1 N 2 node metastasis. In the patients with serosal invasion positive tumors or tumors size over 5 cm, the incidence of 16a2b1 metastasis was high, and that of entire stomach cancer was up to 38 5%. The 3 year and 5 year survival rates for D 3 PAL group were 60 7% and 50 0% respectively. After D 3 PAL, the 1 and 2 year survival rate,of patients with 16a2b1 metastasis were 60 0%, 50 0% respectively. Conclusions D 2 lymphadenectomy should be taken for patients with early gastric cancer and D 3 lymphadenectomy for those with relatively early' advanced gastric cancer. For advanced gastric cancer with suspect or confirmed N 1 N 2 node metastasis, tumor size over 5 cm and/or serosa invasion, D 3 plus para aortic lymphadenectomy appears to be a necessary surgical procedure.