联合脾切除治疗胃上部癌No．10淋巴结转移的疗效

目的探讨D2根治术联合脾切除对进展期胃上部癌No．10淋巴结转移患者预后的影响。方法1980年1月至2002年12月，对216例进展期胃上部癌N0．10淋巴结转移患者施行D2根治术，其中联合脾切除术者（切脾组）73例，未联合脾切除术者（保脾组）143例。比较两组患者术后5年生存率、No．10淋巴结清扫数目及转移数目及术后并发症发生率和病死率。结果216例进展期胃上部癌No．10淋巴结转移患者中，切脾组和保脾组术后5年生存率分别为30．0％和19．7％，两组差异有统计学意义（P〈0．05）。切脾组No．10淋巴结清扫数目及转移数目均明显高于保脾组（P〈0．05）。是否联合脾切除、肿瘤浸润深度和胃切除方式为影响预后的独立因素。T3期患者切脾组与保脾组5年生存率分别为38．7％和18．9％，两组差异有统计学意义（P〈0．05）；全胃切除患者切脾组与保脾组5年生存率分别为33．4％和20．7％，两组差异有统计学意义（P〈0．05）。切脾组和保脾组术后并发症发生率分别为24．7％和17．5％，病死率则分别为4．1％和3．5％，两组差异均无统计学意义（P〉0．05）。结论联合脾切除有利于进展期胃上部癌No．10淋巴结清扫。对于T3期胃上部癌No．10淋巴结转移患者，施行全胃联合脾切除能够提高疗效，不会增加患者术后并发症发生率和病死率。

Efficacy of combined splenectomy in proximal gastric cancer with No.10 lymph node metastasis

Objective To explore the impact on prognosis of D2 lymphadenectomy combined with splenectomy in patients of advanced proximal gastric cancer with No.10 lymph node metastasis. Methods Clinical data of 216 patients of advanced proximal gastric cancer with No.10 lymph node metastasis undergone D2 curative resection in our hospital from January 1980 to December 2002 were analyzed retrospectively. Among them, 73 underwent simultaneous splenectomy (splenectomy group), while 143 without splenectomy (spleen-preserving group). The 5-year survival rate, the mean numbers of dissected No.10 lymph nodes and metastatic No.10 lymph nodes, the complication morbidity and mortality were compared between the two groups. Results The 5-year survival rates of splenectomy group and spleen-preserving group were 30.0% and 19.7% respectively, whose difference was significant (P0.05). Conclusions Splenectomy is benefit for No.10 lymph node dissection in patients with advanced proximal gastric cancer. To improve the prognosis, total gastrectomy combined with splenectomy should be recommended for patients of T3 proximal gastric cancer with No.10 lymph node metastasis. Simultaneous splenectomy dose not increase the complication morbidity and mortality.