CAJ | 학술논문

目的探讨进展期胃癌脾门区淋巴结（No.4sa、No.10和No.11d）转移状况及清扫方式。方法回顾性分析北京肿瘤医院2006年1月至2009年12月590例行近端或全胃切除术并标准D2淋巴结清扫术患者的临床资料，分析临床病理因素对该区淋巴结转移的影响,并分析联合脾或胰体尾切除对该区淋巴结清扫的影响。结果全组病例脾门区淋巴结转移度（阳性淋巴结数目占清扫淋巴结总数）为17.5％(99/565),其中No.4sa、10、11d淋巴结转移度分别为17.8％(41/230)、13.9％(29/209)和22.8％(29/127)。脾门区淋巴结转移率（转移患者数/患者总数）为7.1％(42/590)。多因素分析结果显示，年龄、肿瘤大小、浸润深度、No.4sb淋巴结转移是脾门区淋巴结转移的独立危险因素（均P＜0.05）。联合脾或胰体尾切除病例（23例）和未行联合脏器切除病例数（553例）脾门区淋巴结转移度分别为14.8％(4/27)和17.2％(91/527)，差异无统计学意义(P＞0.05)；术后并发症发生率分别为26.1％(6/23)和5.4％(30/553);差异有统计学意义（P＜0.05）；围手术期死亡率分别为4.3％(1/23)和0.9％(5/553)，差异无统计学意义(P＞0.05)。结论脾门区淋巴结存在着一定的转移规律，其与肿瘤部位、大小、浸润深度及No.4sb淋巴结转移密切相关。联合脾或胰体尾切除并未增加脾门区淋巴结的清扫数目和阳性淋巴结的检出，反而增加了术后并发症的发生率，应谨慎施行。
목적 탐토진전기위암비문구림파결（No.4sa、No.10화No.11d）전이상황급청소방식。방법 회고성분석북경종류의원2006년1월지2009년12월590례행근단혹전위절제술병표준D2림파결청소술환자적림상자료，분석림상병리인소대해구림파결전이적영향,병분석연합비혹이체미절제대해구림파결청소적영향。결과 전조병례비문구림파결전이도（양성림파결수목점청소림파결총수）위17.5％(99/565),기중No.4sa、10、11d림파결전이도분별위17.8％(41/230)、13.9％(29/209)화22.8％(29/127)。비문구림파결전이솔（전이환자수/환자총수）위7.1％(42/590)。다인소분석결과현시，년령、종류대소、침윤심도、No.4sb림파결전이시비문구림파결전이적독립위험인소（균P＜0.05）。연합비혹이체미절제병례（23례）화미행연합장기절제병례수（553례）비문구림파결전이도분별위14.8％(4/27)화17.2％(91/527)，차이무통계학의의(P＞0.05)；술후병발증발생솔분별위26.1％(6/23)화5.4％(30/553);차이유통계학의의（P＜0.05）；위수술기사망솔분별위4.3％(1/23)화0.9％(5/553)，차이무통계학의의(P＞0.05)。결론 비문구림파결존재착일정적전이규률，기여종류부위、대소、침윤심도급No.4sb림파결전이밀절상관。연합비혹이체미절제병미증가비문구림파결적청소수목화양성림파결적검출，반이증가료술후병발증적발생솔，응근신시행。
Objective To study the status of splenic hilar lymph nodes (No.4sa, No.10 or No.11d lymph nodes) metastasis and to investigate the proper dissection technique in patients with advanced gastric cancer. Methods A retrospective study was performed to investigate 590 patients who underwent D2 curative proximal or total gastrectomy for gastric carcinoma from January 2006 to December 2009. Clinicopathological factors such as sex, age, location of the primary tumor, tumor sizes, gross type, depth of invasion, microscopic classification, neoadjuvant chemotherapy and the metastasis of adjacent lymph node were analyzed with univariate and multivariate analysis. Influence of combined splenectomy or pancreatectomy on lymph node dissection was also investigated. Results The overall ratio of metastatic lymph node (positive lymph nodes/lymph nodes harvested) in the splenic hilum was 17.5％(99/565). The positive rates of No.4sa, No.10, No.lid lymph nodes were 17.8％(41/230), 13.9％(29/209), and 22.8％(29/127), respectively. A total of 7.1％(42/590) of the patients had lymph node metastasis in the splenic hilum. Multivariable logistic regression analysis showed that age, tumor size, depth of tumor invasion, positive metastasis of No.4sb lymph node were independent risk factors for lymph node metastasis in the splenic hilum region. When comparing patients undergoing combined splenectomy or pancreatectomy (n=23) and those who did not undergo combined organ resection (n=553), the ratios of metastatic lymph node in the splenic hilum were 14.8％(4/27) and 17.2％(91/527), respectively, and the difference was not statistically significant (P＞0.05). The postoperative complication rates were 26.1％ (6/23) and 5.4％ (30/553), respectively, and the difference was statistically significant (P＜0.05). The operative mortality rates were 4.3％ and 0.9％, respectively, and the difference was not statistically significant(P＞0.05). Conclusions Metastasis to lymph nodes in the splenic hilum region in patients with gastric cancer possesses a certain pattern, and it is associated with tumor location, size, depth of invasion, and metastasis in No.4sb. Combined resection of the spleen or pancreas does not result in increased number of harvested lymph nodes or positive lymph nodes, yet is associated with higher complication rate. Therefore, combined organ resection should be meticulous.