从胃淋巴流向动态规律看胃癌根治术时胃壁切除范围及是否切除脾脏

目的：胃癌根治性手术时胃壁切除的范围是否合理，将直接决定术后能否局部复发及术后残胃功能。方法：应用20％普鲁士兰氯仿溶液作为淋巴道染剂，对138具婴幼儿尸体胃淋巴流向动态规律进行深入研究。结果：胃壁淋巴流注具有规律性，即胃窦与胃底的淋巴管以胃左，右动脉交汇处与胃网膜左，右动脉交汇处连线（以下简称其为b线）为分界，超过b线进入另一侧分别仅为4％和10％，而胃体部的淋巴管则可向胃窦和胃体两个方向引流，从胃底前壁纵轴的中心线与b线的中点连线称其为p线，当注入点在p线大弯侧及小弯侧时，第10组淋巴结染色率分别为97％和3％，经统计学处理有极显著的差别。结论：胃窦和胃底癌行根治性手术时，胃壁的切除范围一般不应少于b线，具体超出多少还要结合病灶大小及其距此连线距离而定，癌细胞最远可侵犯癌缘外5cm，胃壁切除时可以参考；胃体癌行根治性手术时则应考虑行全胃切除。癌灶位于p线左侧及b线上方的进展期胃癌则应联合脾脏切除，只有这样才能彻底清扫第10组淋巴结，更好地防止局部复发。

To Decide the Range of Stomach Resection in Gastric Cancer Radical Operation According to the Dynamic Rule of Stomach Lymphatic Flowing

Objective:The rationality of the range of gastric wall to be resected in radical op eration of gastric cancer may avoid the possibility of recurrence and retains the residual stom ach function.Methods:Using20%Prussian Blue Chloroform Solution as lymphatic dye,we studied the dynamic rule of stomach lymphatic flowing from138infant corpses.Results:Lym phatic flowing directions in the stomach wall had its own regulation.The lymphatic channel of the antrum and fundus of the stomach could be divided by the connecting line from the junction of left/right gastric arteries to the junction of left/right gastro-epiploic arteries(B line).There were only4%and10%of it passed over from one to the other side respectively,and the lymphatic vessel of the corpus of stomach drained into the body of stomach and antrum.The connecting line from the longitudinal axis of the anterior wall of fundus to the mid point of the B line was named P line.When the drained in point at the greater or lesser curvatures on the P line,the stained rate of tenth group lymph nodes were97%and3%with significant statistic difference. Conclusion:Generally the resection range of the stomach wall in radical operation of cancer of gastric antrum or fundus should not be lower than the B line.Precisely how much can be exceeeded above the B line should be decided accord ing to the size of the fo cus and its distance to the B line.The cancer cells can invade even as far as5cm from the edge of cancer.Total gastrectomy should be considered for cancer of the corpus of stomach.Splenectomy should be performed in radical resection of advancing stom ach corpus cancer at the left side of P line and above B line,so that the tenth group lymph nodes can be dissected for preventing the local re currence of cancer.