CAJ | 학술논문

目的探讨胃食管连接部腺癌淋巴结转移的规律,总结该处淋巴结清扫的范围.方法回顾手术治疗198例胃食管连接部腺癌患者的手术方式、Siewert分型、病理分期及各组淋巴结转移情况,探讨淋巴结转移的规律.结果 198例患者均行胸、腹两野淋巴结清扫术,淋巴结转移度为27.99％,淋巴结转移率为66.67％.淋巴结逐站转移130例,占98.48％(130/132例),跳跃式淋巴结转移1.52％(2/132例),分别转移置胃左动脉及腹腔干周围和隆凸下区.Ⅰ、Ⅱ型各组淋巴结转移率分别为:隆凸下淋巴结(6.25％、3.33％)、胸下段食管旁及下纵隔淋巴结( 25.00％、14.67％)、贲门右淋巴结(47.92％、52.00％)、贲门左淋巴结(31.25％、36.67％)、胃小弯淋巴结(43.75％、43.33％)、胃大弯淋巴结(27.08％、22.00％)、胃左动脉旁及腹腔干周围淋巴结(27.08％、30.00％).T1 +T2期者淋巴结转移率40.43％,T3+T4期者淋巴结转移率74.83％,两者间差异有统计学意义.Siewert Ⅰ型纵隔淋巴结转移率(27.08％)显著高于SiewertⅡ型者(14.67％),两者腹腔淋巴结转移率差异无统计学意义.结论 Siewert Ⅰ、Ⅱ型胃食管连接部腺癌有明显的胸、腹双向转移的趋势,应行胸、腹两野淋巴结清扫术,改良左胸切口能满足手术需要.
목적 탐토위식관련접부선암림파결전이적규률,총결해처림파결청소적범위.방법 회고수술치료198례위식관련접부선암환자적수술방식、Siewert분형、병리분기급각조림파결전이정황,탐토림파결전이적규률.결과 198례환자균행흉、복량야림파결청소술,림파결전이도위27.99％,림파결전이솔위66.67％.림파결축참전이130례,점98.48％(130/132례),도약식림파결전이1.52％(2/132례),분별전이치위좌동맥급복강간주위화륭철하구.Ⅰ、Ⅱ형각조림파결전이솔분별위:륭철하림파결(6.25％、3.33％)、흉하단식관방급하종격림파결( 25.00％、14.67％)、분문우림파결(47.92％、52.00％)、분문좌림파결(31.25％、36.67％)、위소만림파결(43.75％、43.33％)、위대만림파결(27.08％、22.00％)、위좌동맥방급복강간주위림파결(27.08％、30.00％).T1 +T2기자림파결전이솔40.43％,T3+T4기자림파결전이솔74.83％,량자간차이유통계학의의.Siewert Ⅰ형종격림파결전이솔(27.08％)현저고우SiewertⅡ형자(14.67％),량자복강림파결전이솔차이무통계학의의.결론 Siewert Ⅰ、Ⅱ형위식관련접부선암유명현적흉、복쌍향전이적추세,응행흉、복량야림파결청소술,개량좌흉절구능만족수술수요.
Objective To summarizeand the law of lymph node metastases from adenocareinoma of esophagogastric junction ( AEG),analyses the extent of lymphadenectomy for AEG.Methods 198 cases of AEG had been retrospectively analyzed from 2006.6.6 to 2010.12.31,and kept detailed record of the operation type、Siewert's type、TNM stage and group of metastatic lymph nodes.Results The thoraco-abdominal two field lymph node dissection had been performed for 198 AEG,the total number of lymph nodes had been dissected was 3069,the average number was 15.50,the number of metastases lymph nodes was 859.In the 198 AEG,132 cases with lymph node positive,The metastatic rate and incidence was 66.67％ and 27.99％,respectively.The manner of the metastasis about 130 cases was station by station and 2 cases was skipping over station,accout for 98.48％ and 1.52％ of all nodes-positive cases,1 case skiped to left gastric and celiac axis and another case skiped to tracheal bifurcation.The location of positive lymph nodes about Siewert Ⅰ and Ⅱ were recorded:tracheal bifurcation(6.25％,3.33％ ) 、lower posterior mediastinum and paraoesophageai(25.00％,14.67％ ),right paracardiac (47.92％,52.00％ ),left paracardiac (31.25％,36.67％ ) 、lesser curvatura(43.75％,43.33％ ),greater curvatura( 27.08％,22.00％ ) 、left gastric and celiac axis( 27.08％,30.00％ ).The lymph nodes metastastic rate of stage T1 + T2 and T3 + T4 were 40.43％,74.83％,respectively,the difference were significantly.The lymph nodes metastastic rate of different tumor length were analyzed,≤ 3cm group were 40.74％,3 ～5cm group were 70.71％ and ≥5cm group were 88.89％,the difference were significantly;but there were no significant difference related to different differentiation grades and different Siewert types.The mediastinal lymph node metastase rates between Siewert Ⅰ (27.08％) and Siewert Ⅱ (14.67％) were significant difference,but the difference were not found in pericardiac lymph nodes.Conclusion Siewert Ⅰ 、Ⅱ AEG trend to metastasized to middle and low mediastinal and pericardiac,the modified left thansthoracic route and two field lymph node dissection maybe suitable to the lymphadenectomy for AEG.