CAJ | 학술논문

目的观察胃癌手术保留胰脾清除脾门和脾动脉干淋巴结(即No 10、11)合理性和可行性.方法分析439例手术切除的胃贲门、体部和全胃癌侵入胰脾情况;对54例胃癌患者在术中从贲门和体部浆膜下注入亚甲兰观察胃的淋巴流向;63例胃癌采用保留胰脾功能性清除No 10、11 淋巴结方法,与同期保胰法和胰脾切除法比较,分析No 10、11淋巴结转移率,观察术后并发症发生率和生存率.结果 439例胃贲门、体部和全胃癌侵入胰脾机会不多,分别为5.7%(25/439)和2.3%910/439);5 4例胃的美兰淋巴引流不进入脾脏和胰腺内.保留胰脾法、保胰法和脾胰切除法3组No 10、1 1淋巴结转移率分别为17.5%(11/63),19.1%(12/63);20.8%(45/216),25%(54/216);20%( 6/30),23%(7/30),差异无显著意义.63例保留胰脾法术后并发症发生率和病死率均较保留胰法和胰脾联合切除法低,而生存期较高,5年、10年生存率分别为57.5%、52%,57.4%、47 .4%和37.3%、30%.Ⅱ、Ⅲa期患者保留胰脾手术的5年、10年生存率明显改善.结论保胰脾法是一个安全、切实可行的保留脏器功能的胃癌根治手术,术后并发症低、生存率高 .尤对Ⅱ、Ⅲa期患者应行保留胰脾手术.
목적관찰위암수술보류이비청제비문화비동맥간림파결(즉No 10、11)합이성화가행성.방법분석439례수술절제적위분문、체부화전위암침입이비정황;대54례위암환자재술중종분문화체부장막하주입아갑란관찰위적림파류향;63례위암채용보류이비공능성청제No 10、11 림파결방법,여동기보이법화이비절제법비교,분석No 10、11림파결전이솔,관찰술후병발증발생솔화생존솔.결과 439례위분문、체부화전위암침입이비궤회불다,분별위5.7%(25/439)화2.3%910/439);5 4례위적미란림파인류불진입비장화이선내.보류이비법、보이법화비이절제법3조No 10、1 1림파결전이솔분별위17.5%(11/63),19.1%(12/63);20.8%(45/216),25%(54/216);20%( 6/30),23%(7/30),차이무현저의의.63례보류이비법술후병발증발생솔화병사솔균교보류이법화이비연합절제법저,이생존기교고,5년、10년생존솔분별위57.5%、52%,57.4%、47 .4%화37.3%、30%.Ⅱ、Ⅲa기환자보류이비수술적5년、10년생존솔명현개선.결론보이비법시일개안전、절실가행적보류장기공능적위암근치수술,술후병발증저、생존솔고 .우대Ⅱ、Ⅲa기환자응행보류이비수술.
Objective To study the clinical value of radical resection of gastric carcinoma with pancr eas and spleen preservation (PSP) and functional cleaning of lymph nodes (LNs) o f the spleen hillus and along the splenic artery.Methods Pancreas and spleen involvement was retrospectively reviewed among 439 cases of resectable carcinoma of the gastric cardia,gastric corpus and total stomach. Du ring gastric surgery, 2 ml of methylene blue was injected into the subserosal sp ace of the gastric cardia or corpus to observe the spread of lymphatic flow in 5 4 cases of gastric carcinoma. The metastatic rate of LNs in splenic hillus and along the trunk of the splenic artery (No10, No11), postoperative complications and survival rates were investigated in 63 gastric carcinoma patients that had r eceived gastrectomy with pancreas and spleen preservation (PSP). These were com pared with the pancreas preservation (PP) group and pancreas and spleen combined resection (PSR) group.Results Among these 439 cases, only 25 cases were observed with direct invasion to the p ancreas (5.7%), and 10 cases with direct invasion to the spleen (2.3%). After pathological examination of the pancreatic body and tail, we found 22 cases wit h pancreas and spleen combined resection, 4 cases (18.2%, 4/22) with direct inv asion of the capsule and 2 with invasion to the superficial parenchyma (9.1%, 2 /22), without metastasis to the lymph nodes within the pancreas and spleen. The metastatic rate of No10,No11 lymph nodes were 17.5% (11/63) and 19.1% (12/63 ) in the PSP group, 20.8% (45/216) and 25%(54/216) in the PP group, and 20% (6/ 30) and 23.3% (7/30) in the PSR group. There were no statistically signific ant differences (P>0.05). Injection of methylene blue into the subserosal space of the stomach did not diffuse into the spleen or pancreatic parenchyma. Postoperative complications, diabetes and mortality in PSP (0%,0%,0%) were lowe r than in PP (4.2%, 0.9%, 0.9%) or PSR (40%,10%,3.3%). The 5-year surviva l rate (5-YSR) and 10-YSR in PSP (57.5%, 52.0%) were higher than in PSR (37 .5%,30.0%). Those patients with stage Ⅱ and Ⅲa treated by PSP, improved m arkedly.Conclusions The surgical procedure of pancreas and spleen preservation for gastric cancer is a safe and organ function protected method. Postoperative complications were l ower and survival rates were higher , the radicality was not reduced. These re sults indicate that PSP is preferred in patients with gastric carcinoma of stage Ⅱ or Ⅲa.