论文部分内容阅读
目的探讨残胃癌淋巴结转移的特点,为残胃癌术中合理的淋巴结清扫提供依据。方法回顾性分析广西壮族自治区人民医院普外-儿外科2004年6月至2012年6月期间由同一手术者进行残胃癌根治术的22例患者的临床资料,并用等距随机抽样法随机抽取同期原发性胃癌患者50例作为对照,比较2组患者的临床病理资料及术中所清扫淋巴结的转移情况。结果与原发性胃癌患者相比,残胃癌患者联合脏器切除率较高〔54.55%(12/22)比14.00%(7/50)〕,差异有统计学意义(χ2=12.929,P=0.000)。在淋巴结转移方面,残胃癌患者淋巴结总转移阳性率明显高于原发性胃癌患者〔30.56%(103/337)比22.13%(208/940)〕,差异有统计学意义(χ2=9.583,P=0.002);微转移方面,残胃癌患者淋巴结微转移阳性率高于原发性胃癌〔2.97%(10/337)比1.49%(14/940)〕,但差异无统计学意义(χ2=2.939,P=0.086)。残胃癌患者No.10淋巴结总转移阳性率较原发性胃癌患者高〔52.17%(12/23)比17.39%(4/23)〕,差异有统计学意义(χ2=6.133,P=0.013);残胃癌患者No.10的12个转移淋巴结中有4个微转移,原发性胃癌中未检出微转移淋巴结。残胃癌空肠系膜淋巴结转移阳性率为35.71%(5/14)。结论残胃癌有其独特的淋巴结转移规律,术中应行D2淋巴结廓清术和空肠系膜淋巴结清扫术,同时应重点对No.10淋巴结进行清扫,必要时行联合脏器切除。
Objective To investigate the characteristics of lymph node metastasis of gastric stump carcinoma and provide basis for rational lymph node dissection in gastric stump carcinoma. Methods The clinical data of 22 patients with radical gastric cancer radical resection performed by the same surgeon from June 2004 to June 2012 in People’s Hospital of Guangxi Zhuang Autonomous Region were retrospectively analyzed. The patients were randomly selected by the same period random sampling method 50 cases of primary gastric cancer patients as a control, clinical and pathological data were compared between 2 groups of patients and surgical dissection of lymph node dissection. Results Compared with patients with primary gastric cancer, the resection rate of patients with residual gastric cancer was higher (54.55% (12/22) vs 14.00% (7/50)], the difference was statistically significant (χ2 = 12.929, P = 0.000). In lymph node metastasis, the positive rate of total lymph node metastasis in gastric cancer was significantly higher than that in primary gastric cancer 〔30.56% (103/337) vs 22.13% (208/940〕〕, the difference was statistically significant (χ2 = 9.583, P = 0.002). In micrometastasis, the positive rate of lymph node micrometastasis in patients with gastric stump cancer was higher than that in primary gastric cancer 〔2.97% (10/337) vs 1.49% (14/940〕〕), but the difference was not statistically significant (χ2 = 2.939 , P = 0.086). The positive rate of total lymph node metastasis No.10 in patients with gastric cancer was significantly higher than that in patients with primary gastric cancer [52.17% (12/23) vs 17.39% (4/23)], the difference was statistically significant (χ2 = 6.133, P = 0.013) ; Gastric cancer patients No.10 of 12 metastatic lymph nodes in 4 micrometastases, no detection of micrometastasis in primary gastric cancer. The positive rate of gastric residual mesenteric lymph node metastasis was 35.71% (5/14). Conclusion Stomach cancer has its own unique rule of lymph node metastasis. D2 lymph node dissection and jejunum lymphadenectomy should be performed intraoperatively. At the same time, it is necessary to focus on No.10 lymph node dissection, and if necessary, joint organ excision.