CAJ | 학술논문

目的探讨远端胃癌患者正常肝动脉及异常肝动脉周围淋巴结的微转移及清扫的必要性，为胃癌D2根治术中合理地选择淋巴清扫范围提供依据。方法选择广西医科大学第一附属医院胃肠外科2008年6月至2010年6月间由同一手术者进行远端胃癌D2根治术的60例胃癌患者，对正常肝动脉及源自肠系膜上动脉异常肝动脉周围淋巴脂肪组织行重组人细胞角蛋白20(CK20)和CEA微转移免疫组化检查，从而判断正常及异常肝动脉周围是否有淋巴结转移的发生。结果本组经CK20和CEA微转移免疫组化测定，正常肝动脉周围淋巴结转移率为27％，患者年龄、肿瘤大小、Borrmann分型、TNM分期均为转移的影响因素。存在源自肠系膜上动脉异常肝动脉的患者共7例，变异率为12％，其中走行于胰腺前方的1例，胰腺后方的6例，胰前、后型异常血管周围淋巴组织中未发现淋巴结转移。结论 CK20和CEA免疫组化检查是检测淋巴结微转移良好的指标；对于年龄≥60岁、肿瘤＞3 cm、BorrmannⅢ～Ⅳ型的远端胃癌患者，走行正常的肝动脉周围淋巴结转移率甚高，术者应重视对此处淋巴结的清扫；发自肠系膜上动脉的异常肝动脉周围淋巴结转移率则很低。
목적 탐토원단위암환자정상간동맥급이상간동맥주위림파결적미전이급청소적필요성，위위암D2근치술중합리지선택림파청소범위제공의거。방법 선택엄서의과대학제일부속의원위장외과2008년6월지2010년6월간유동일수술자진행원단위암D2근치술적60례위암환자，대정상간동맥급원자장계막상동맥이상간동맥주위림파지방조직행중조인세포각단백20(CK20)화CEA미전이면역조화검사，종이판단정상급이상간동맥주위시부유림파결전이적발생。결과 본조경CK20화CEA미전이면역조화측정，정상간동맥주위림파결전이솔위27％，환자년령、종류대소、Borrmann분형、TNM분기균위전이적영향인소。존재원자장계막상동맥이상간동맥적환자공7례，변이솔위12％，기중주행우이선전방적1례，이선후방적6례，이전、후형이상혈관주위림파조직중미발현림파결전이。결론 CK20화CEA면역조화검사시검측림파결미전이량호적지표；대우년령≥60세、종류＞3 cm、BorrmannⅢ～Ⅳ형적원단위암환자，주행정상적간동맥주위림파결전이솔심고，술자응중시대차처림파결적청소；발자장계막상동맥적이상간동맥주위림파결전이솔칙흔저。
Objective To study the dissecting necessity of lymph node around normal and abnormal hepatic artery in distal gastric cancer undergoing D2 lymphadenectomy. Methods Sixty gastric cancer patients receiving distal D2 lymphadenectomy by the same surgeon between June 2008 to June 2010 at the Department of Gastrointestinal Surgery, First Affiliated Hospital of the Guangxi Medical University were included in this study. The lymph adipose tissue around the anatomically normal and aberrant hepatic artery was carefully dissected, and the lymph nodes sent for recombinant human cytokeratin 20 (CK20) and carcino-embryonic antigen ( CEA ) micrometastasis immunohistochemistry.Results With the micrometastasis immunohistochemistry of CK20 and CEA, we found the metastasise rate of lymph node around the normal hepatic artery was 27％. Patient age, tumor size, Borrmann type, TNM staging were correlated with the lymph node metastase. There were 7 cases with abnormal hepatic artery originating from the superior mesenteric artery. The hepatic artery ran in front of the pancreas in 1 case and behind the pancreas in 6 cases. We found there are no metastases in the lymph adipose tissue surrounding the abnormal artery. Conclusions CK20,CEA are suitable immunohistochemical targets for estimating the lymph node micrometastasis. In distal gastric cancer age at 60 or older years, tumor larger than 3 cm and Borrmann Ⅲ-Ⅳ type were risk factors for metastasis of lymph nodes around normal hepatic artery, while aberrant hepatic arteries originating from the superior mesenteric artery are much less likely to have positive lymph nodes in D2 lymphadenectomy.