中华普通外科杂志
中華普通外科雜誌
중화보통외과잡지
CHINESE JOURNAL OF GENERAL SURGERY
2014年
6期
416-420
,共5页
倪中凯%姚凯%程川兵%李树仁%王道明%孔琦%朱家胜
倪中凱%姚凱%程川兵%李樹仁%王道明%孔琦%硃傢勝
예중개%요개%정천병%리수인%왕도명%공기%주가성
胃肿瘤%淋巴结切除术%肿瘤转移
胃腫瘤%淋巴結切除術%腫瘤轉移
위종류%림파결절제술%종류전이
Stomach neoplasms%Lymph node excision%Neoplasm metastasis
目的 研究远端胃癌行D2根治术中清除第12组淋巴结的意义和方法.方法 回顾性分析皖南医学院附属弋矶山医院自2011年9月至2013年9月期间193例远端胃癌患者行远端胃或全胃D2根治术的清扫第12组淋巴结的临床病理资料.结果 BorrmannⅢ、Ⅳ型胃癌患者中第12a组淋巴结转移率明显高于Borrmann Ⅰ、Ⅱ型(x2=4.841,P=0.028);胃角、胃窦及多发癌第12a组淋巴结转移率分别为11.1％、9.7％、30.4％,第12p组淋巴结转移率分别为0、2.15％、19.6％,多发癌的淋巴结转移率明显高于胃角、胃窦各区;高-中分化胃癌第12a组淋巴结转移率低于低分化者(x2=4.292,P=0.038),高-中分化胃癌第12b组淋巴结转移率低于低分化者(x2=4.079,P=0.043);浆膜受侵患者第12a组淋巴结转移率高于浆膜未受侵者(x2=8.107,P=0.004),浆膜受侵者第12b组淋巴结转移率高于浆膜未受侵者(x2=3.836,P=0.050);N0～1第12a组淋巴结转移率低于N2～3 (x2=10.960,P=0.001),N0 ～1第12b组淋巴结转移率低于N2～3 (x2 =4.989,P=0.026),N0～1第12p组淋巴结转移率低于N2～3 (x2 =4.433,P=0.035);肿瘤直径＜3 cm、3～5 cm和＞5 cm第12a组淋巴结转移率分别为4.2％、10、0％、29.2％,直径在5 cm以上的肿瘤发生第12a组淋巴结转移的概率较大(x2=6.464,P=0.011).结论 远端胃癌D2根治术行第12组淋巴结的清扫是合理必要的.
目的 研究遠耑胃癌行D2根治術中清除第12組淋巴結的意義和方法.方法 迴顧性分析皖南醫學院附屬弋磯山醫院自2011年9月至2013年9月期間193例遠耑胃癌患者行遠耑胃或全胃D2根治術的清掃第12組淋巴結的臨床病理資料.結果 BorrmannⅢ、Ⅳ型胃癌患者中第12a組淋巴結轉移率明顯高于Borrmann Ⅰ、Ⅱ型(x2=4.841,P=0.028);胃角、胃竇及多髮癌第12a組淋巴結轉移率分彆為11.1％、9.7％、30.4％,第12p組淋巴結轉移率分彆為0、2.15％、19.6％,多髮癌的淋巴結轉移率明顯高于胃角、胃竇各區;高-中分化胃癌第12a組淋巴結轉移率低于低分化者(x2=4.292,P=0.038),高-中分化胃癌第12b組淋巴結轉移率低于低分化者(x2=4.079,P=0.043);漿膜受侵患者第12a組淋巴結轉移率高于漿膜未受侵者(x2=8.107,P=0.004),漿膜受侵者第12b組淋巴結轉移率高于漿膜未受侵者(x2=3.836,P=0.050);N0～1第12a組淋巴結轉移率低于N2～3 (x2=10.960,P=0.001),N0 ～1第12b組淋巴結轉移率低于N2～3 (x2 =4.989,P=0.026),N0～1第12p組淋巴結轉移率低于N2～3 (x2 =4.433,P=0.035);腫瘤直徑＜3 cm、3～5 cm和＞5 cm第12a組淋巴結轉移率分彆為4.2％、10、0％、29.2％,直徑在5 cm以上的腫瘤髮生第12a組淋巴結轉移的概率較大(x2=6.464,P=0.011).結論 遠耑胃癌D2根治術行第12組淋巴結的清掃是閤理必要的.
목적 연구원단위암행D2근치술중청제제12조림파결적의의화방법.방법 회고성분석환남의학원부속익기산의원자2011년9월지2013년9월기간193례원단위암환자행원단위혹전위D2근치술적청소제12조림파결적림상병리자료.결과 BorrmannⅢ、Ⅳ형위암환자중제12a조림파결전이솔명현고우Borrmann Ⅰ、Ⅱ형(x2=4.841,P=0.028);위각、위두급다발암제12a조림파결전이솔분별위11.1％、9.7％、30.4％,제12p조림파결전이솔분별위0、2.15％、19.6％,다발암적림파결전이솔명현고우위각、위두각구;고-중분화위암제12a조림파결전이솔저우저분화자(x2=4.292,P=0.038),고-중분화위암제12b조림파결전이솔저우저분화자(x2=4.079,P=0.043);장막수침환자제12a조림파결전이솔고우장막미수침자(x2=8.107,P=0.004),장막수침자제12b조림파결전이솔고우장막미수침자(x2=3.836,P=0.050);N0～1제12a조림파결전이솔저우N2～3 (x2=10.960,P=0.001),N0 ～1제12b조림파결전이솔저우N2～3 (x2 =4.989,P=0.026),N0～1제12p조림파결전이솔저우N2～3 (x2 =4.433,P=0.035);종류직경＜3 cm、3～5 cm화＞5 cm제12a조림파결전이솔분별위4.2％、10、0％、29.2％,직경재5 cm이상적종류발생제12a조림파결전이적개솔교대(x2=6.464,P=0.011).결론 원단위암D2근치술행제12조림파결적청소시합리필요적.
Objective To study the significance of No12 lymphadenectomy in patients of advanced distal gastric cancer undergoing D2 distal or total gastrectomy.Methods Clinical and pathological data of 193 distal gastric cancer cases undergoing D2 gastrectomy and No12 lymphadenectomy during Jan 2012 and Jan 2013 were analyzed retrospectively.Results In Borrmann Ⅲ,Ⅳ No.12a LN metastasis was significantly higher than that in Borrmann Ⅰ,Ⅱ (x2 =4.841,P =0.028).In cases of multiple cancer 12a LN metastasis was significantly higher than that in gastric angle,gastric antrum (11.1％ 、9.7％ 、30.4％).High-differentiated cancer was lower in LN metastasis than that of low differentiated both in No.12a group (x2 =4.292,P =0.038),and in No.12b group (x2 =4.079,P =0.043).In cases with serosal invasion LN metastasis was higher than that without infiltration both in No.12a group (x2 =8.107,P =0.004),and in 12b group (x2 =3.836,P =0.050).In cases of N 0 ～ 1 the LN metastasis was lower than that in N 2 ～ 3 in 12a group (x2 =10.960,P=0.001),12b group (x2 =4.989,P =0.026),and in 12p group (x2 =4.433,P =0.035 respectively).In cases of tumor diameter ＜3 cm,3 ～5 cm and ＞5 cm,the 12a lymph node metastasis rate was 4.2％,10.0％,and 29.2％,respectively.Tumor size ＞ 5 cm has higher metastasis rate in No.12a group (x2 =6.464,P =0.011).Conclusions No.12 lymphadenectomy should be included routinely in D2 gastrectomy in patients of distal gastric carcinoma.
