目的：探讨远端胃癌淋巴结转移规律与淋巴结清扫方式的选择。方法257例远端胃癌的患者，观察肿瘤浸润深度和淋巴结转移情况，采用的淋巴结清扫方式为 D1术（24例）、D1＋清扫术（66例），D2清扫术（167例），分析淋巴结清扫方式的合理性。结果全组淋巴结转移率为30.35％（78/257）。肿瘤局限于黏膜患者淋巴结转移的比率为2.3％，明显低于肿瘤位于黏膜下的患者（18.64％，χ2＝15.983，P ＜0.001）。随着肿瘤浸润深度的加深至肌层后，淋巴结转移的比率明显增加。当肿瘤侵犯至浆膜时，第3站淋巴结已出现明显转移（第2组5.88％，第4sb 组3.70％，第10组8％）。结论对于局限于黏膜内的远端胃癌患者，D1清扫术即可；对于浸润肌层或更深层的远端胃癌可行标准 D2清扫术；但对于位于黏膜下的远端胃癌，需要扩大 D1＋清扫术的范围。%Objective To explore the regulation of lymph node metastasis and procedure for dissection of lymph nodes in patients with dis-tal gastric cancer. Methods A total of 257 cases of distal gastric cancer were collected for this study. The approach applied for dissection of lymph nodes was D1 procedure(24 cases),D1 + dissection(66 cases)and D2 dissection(167 cases). The reasonable way for lymphadenectomy had been discussed and analyzed. Results The rate of metastasis of lymph nodes was 30. 35%(78 / 257)in this series. In patients with tumor confined to mucosa,the rate for metastasis of lymph nodes was 2. 3% ,and it was significantly lower than that of patients with submucosal tumor (18. 64% ,χ2 = 15. 983,P < 0. 001). With the deepening of depth for tumor invasion to muscle,the proportion of metastasis in lymph nodes was significantly increased. When the tumor invaded the serosa,3rd group lymph nodes had been significant metastasized(2 nd group 5. 88% ,4 th group 3. 70% ,10 th group 8% ). Conclusion For patients with gastric cancer confined to the distal end of inner mucosa,D1 dissection can be done. For deeper myometrial invasion or distal gastric cancer,standard D2 dissection is feasible. But at the distal gastric mucosa,it needs to ex-pand the range of D1 plus cleaning surgery.
展开▼
