胃癌横结肠系膜前叶及胰腺被膜转移的危险因素分析

摘要

Objective To determine the clinical pathological characteristics of cancerometastasis of anterior layer of transverse mesocolon and pancreatic capsule in gastric cancer ,and to explore the clinical significance of the resection.Methods The effects of factors,including gender,age,tumor location,tumor size,tumor invading depth, lymph node metastasis , degree of histologic differentiation , Borrmann type and TNM staging , on cancerometastasis of anterior layer of transverse mesocolon and pancreatic capsule were analyzed in 126 gastric cancer patients undergoing radicalgastrectomy .Results There were 49 patients with cancerometastasis of anterior layer of transverse mesocolon and pancreatic capsule,the metastasis rate was 38.9%.Univariate and multivariate analysis suggested that cancerometastasis was associated with tumor location,tumor size,tumor invading depth,degree of histologic differentiation and TNM staging (P<0.05),but wasn′t associated with age,gender,lymph node metastasis and Borrmann type (P>0.05).Cancerometastasis often occurred in stageⅡ,Ⅲpatients with L-zone tumor,poorly differentiated mucinous adenocarcinoma or signet ring cell carcinoma,whose tumor diameter≥5 cm,tumor invading depth was T3,T4.Conclusion Radicalgastrectomy should be assessed and conducted according to the biochemical characteristics of tumors .The resection of anterior layer of transverse mesocolon and pancreatic capsule should be reasonable during the operation .%目的：研究胃癌横结肠系膜前叶及胰腺被膜转移的临床病理特征，探讨其切除的临床意义。方法行胃癌根治术患者126例，分析其性别、年龄、肿瘤部位、大小、浸润深度、淋巴结转移、组织分化程度、Borrmann类型及TNM分期对其横结肠系膜前叶和胰腺被膜转移的影响。结果胃癌横结肠系膜前叶、胰腺被膜转移49例，转移率为38．9％。单因素及多因素分析结果显示，转移与肿瘤部位、大小、浸润深度、组织分化程度及TNM分期有关（P＜0．05），而与年龄、性别、淋巴结转移、Borrmann类型与转移无关（P＞0．05），L区肿瘤，肿瘤直径≥5 cm，浸润浓度为T3、T4，低分化、黏液腺癌、印戒细胞癌，病理分期为Ⅲ、Ⅳ期患者更易发生转移。结论胃癌根治术应根据肿瘤本身生物学特性评估并选择术式，合理切除横结肠系膜前叶和胰腺被膜。