中华胃肠外科杂志
中華胃腸外科雜誌
중화위장외과잡지
CHINESE JOURNAL OF GASTROINTESTINAL SURGERY
2013年
7期
632-636
,共5页
梁月祥%梁寒%丁学伟%王晓娜%吴亮亮%刘宏根%焦旭光
樑月祥%樑寒%丁學偉%王曉娜%吳亮亮%劉宏根%焦旭光
량월상%량한%정학위%왕효나%오량량%류굉근%초욱광
胃肿瘤%淋巴结清扫术%肠系膜上静脉%预后
胃腫瘤%淋巴結清掃術%腸繫膜上靜脈%預後
위종류%림파결청소술%장계막상정맥%예후
Stomach neoplasms%Lymphadenctomy%Superior mesenteric vein%Prognosis
目的 探讨进展期胃癌行D2根治术时第14v组淋巴结清扫的必要性.方法 回顾性分析2003至2007年间天津医科大学附属肿瘤医院收治的131例行胃癌根治术(D2或D2+)并同时加行第14v组淋巴结清扫的胃癌患者的临床病理资料,分析影响第14v组淋巴结转移的临床病理因素以及第14v组淋巴结转移与预后的关系.结果 131例患者中24例(18.3％)有第14v组淋巴结转移.原发灶部位、肿瘤大小、浸润深度、淋巴结分期、TNM分期、第1、6、8a组淋巴结转移与第14v组淋巴结转移有关(均P＜0.05)；其中原发灶部位和淋巴结分期是影响第14v组淋巴结转移的独立因素(均P＜0.05).第14v组淋巴结转移和未转移患者5年生存率分别为8.3％和37.8％,差异有统计学意义(P＜0.01).多因素预后分析证实,第14v组淋巴结转移是影响进展期胃癌D2根治术后生存的独立危险因素(P=0.029,RR=1.807,95％CI:1.064～3.070).结论 对于进展期胃中下部癌,尤其是肿瘤体积较大、浆膜受侵犯、第6组淋巴结可疑转移的患者,第14v组淋巴结清扫是必要可行的.
目的 探討進展期胃癌行D2根治術時第14v組淋巴結清掃的必要性.方法 迴顧性分析2003至2007年間天津醫科大學附屬腫瘤醫院收治的131例行胃癌根治術(D2或D2+)併同時加行第14v組淋巴結清掃的胃癌患者的臨床病理資料,分析影響第14v組淋巴結轉移的臨床病理因素以及第14v組淋巴結轉移與預後的關繫.結果 131例患者中24例(18.3％)有第14v組淋巴結轉移.原髮竈部位、腫瘤大小、浸潤深度、淋巴結分期、TNM分期、第1、6、8a組淋巴結轉移與第14v組淋巴結轉移有關(均P＜0.05)；其中原髮竈部位和淋巴結分期是影響第14v組淋巴結轉移的獨立因素(均P＜0.05).第14v組淋巴結轉移和未轉移患者5年生存率分彆為8.3％和37.8％,差異有統計學意義(P＜0.01).多因素預後分析證實,第14v組淋巴結轉移是影響進展期胃癌D2根治術後生存的獨立危險因素(P=0.029,RR=1.807,95％CI:1.064～3.070).結論 對于進展期胃中下部癌,尤其是腫瘤體積較大、漿膜受侵犯、第6組淋巴結可疑轉移的患者,第14v組淋巴結清掃是必要可行的.
목적 탐토진전기위암행D2근치술시제14v조림파결청소적필요성.방법 회고성분석2003지2007년간천진의과대학부속종류의원수치적131례행위암근치술(D2혹D2+)병동시가행제14v조림파결청소적위암환자적림상병리자료,분석영향제14v조림파결전이적림상병리인소이급제14v조림파결전이여예후적관계.결과 131례환자중24례(18.3％)유제14v조림파결전이.원발조부위、종류대소、침윤심도、림파결분기、TNM분기、제1、6、8a조림파결전이여제14v조림파결전이유관(균P＜0.05)；기중원발조부위화림파결분기시영향제14v조림파결전이적독립인소(균P＜0.05).제14v조림파결전이화미전이환자5년생존솔분별위8.3％화37.8％,차이유통계학의의(P＜0.01).다인소예후분석증실,제14v조림파결전이시영향진전기위암D2근치술후생존적독립위험인소(P=0.029,RR=1.807,95％CI:1.064～3.070).결론 대우진전기위중하부암,우기시종류체적교대、장막수침범、제6조림파결가의전이적환자,제14v조림파결청소시필요가행적.
Objective To elucidate the necessity of No.14v lymph node dissection in D2 lymphadenectomy for advanced gastric cancer.Methods Clinicopathological data of 131 cases of advanced gastric cancer receiving D2 or D2+ plus No.14v lymph node dissection were reviewed retrospectively.Clinicopathological factors associated with No.14v lymph node metastasis were analyzed and prognostic value of No.14v lymph node metastasis was evaluated.Results Of the 131 patients,24 (18.3％) had positive No.14v lymph node.The incidence of 14v metastasis was associated with tumor location,tumor size,depth of invasion,N staging,TNM staging,No.1,No.6,and No.8a lymph nodes metastasis.Tumor location and N staging were independent risk factors for No.14v metastasis(all P＜0.05).The 5-year survival rate was 8.3％ and 37.8％ in patients with and without No.14v metastasis respectively.The difference was statistically significant (P＜0.01).Multivariate analysis revealed that metastasis of No.14v was an independent prognostic factor for advanced gastric cancer after D2 lymphadenectomy (P=0.029,RR=1.807,95％CI:1.064-3.070).Conclusions For advanced middle and lower gastric cancers,especially those with larger size,serosa invasion and possibility of No.6 lymph node metastasis,it is necessary and feasible to remove the No.14v lymph node.
