胃癌第16组淋巴结转移与D4式根治术的临床病理研究

外科理论与实践 2000年第2期第5卷 论著

作者：燕敏　徐鸿　尹浩然　朱正纲　李树发　薛建元

单位：上海第二医科大学附属瑞金医院外科(200025)

关键词：进展期胃癌；腹主动脉旁淋巴结；D4式胃癌根治术

　　摘　要：为试行提高胃癌根治术手术的疗效，阐明胃癌生物学特性与第16组淋巴结转移的关系，从而提出合适的D4式根治术指征，探讨此术式的可行性和意义。方法：对我院自1995年9月至1998年11月所行的56例无远处转移的D4式根治术病例，就反映肿瘤生物学特性的各临床、病理参数进行分析，祈能对D4式根治术提出合适的手术指征。结果：在56例D4式根治术中，发现有第16组淋巴结转移者10例，转移率为17.9％；而于浸润型胃癌、肿瘤直径大于5cm、肿瘤侵及浆膜以及第2、3站淋巴结受累时，第16组LN转移率明显增高(P＜0.05)；在第16组的各分区LN中又以16A2和B1区的转移率更高。全组无手术死亡率，手术并发症也未见明显增加。结论：进展期胃癌中有相当一部分发生第16组LN转移，且与胃癌各生物学特性参数相关。在正确掌握手术适应证的基础上，D4式胃癌根治术是相对安全可行的，其对胃癌手术的彻底性和远期疗效的意义，有待进一步积累经验。

A Clinico-pathological Study on Para-aortic Lymph Node Metastasis and D4Dissection for Advanced Gastric Cancer．

yan Min ,Xu Hong,Yin Haoran(Department of Surgery,Ruijin Hospital，Shanghai Second Medical University，Shanghai(200025))

　　Abstract：(1)to assess the significance of D4dissection in treating patients with advanced gastric cancer(AGC)；(2)to elucidate the relationship between the para-aortic lymph node(No.16LN)metastasis and the biological behavior of gastric cancer，and(3)to make out the appropriate indications for D4dissection．Methods：56 cases of AGC without remote metastasis were subjected to D4dissection during the period from September l995 to November 1998 in Ruijin Hospital．Clinico-pathological studies were carried out for all the cases．Results： Ten of the 56 cases were No.16LN positive(17.9％)and the positive rate is significantly increased in cases where the tumor was larger than 5cm in diameter，belonging to the infiltrative type，with serosal involvement and/or N3 positive(P＜0.05)．The incidence of complications occurring in our D4cases was not noticeably increased and there was no operative mortality．Conclusions： Para-aortic lymph node metastasis do occur in some of the advanced gastric cancer patients．Selective D4procedure appears to be relatively safe and feasible．The impact of D4procedure on the long-term prognosis of AGC remains to be clarified by further studies．

　　Keywords：Advanced gastric cancer Para-aortic lymph nodes D4dissection

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收稿日期：1999-08-04