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目的 胃癌手术时是否需要行联合脾切除,这个问题一直有争论。实际上争论的焦点主要集中在脾门淋巴结转移的高低(即第(10)组淋巴结转移率高低)。本文通过从胃淋巴流向动态规律的研究,对这一问题提出自己的观点,并希望对临床有所裨益。方法 我们对138具婴幼儿尸体胃淋巴流注的动态规律观察进行了研究。结果 近端胃癌时第10组淋巴结转移的可能性极大,而远端胃癌时第10组淋巴结转移的可能性相对要小得多。结论 支持进展期胃底癌行极治术时行联合脾切除,而胃窦癌行根治术时则可不联合脾切除术,支持进展期胃体癌行根治术时联合脾切除,特别是病灶偏向大弯侧时更应如此。
Objectives The need for combined splenectomy for gastric cancer surgery has been a matter of debate. In fact, the focus of the debate is mainly on the level of lymph node metastasis in the spleen (ie, the rate of lymph node metastasis in the (10) group). This article presents its own point of view on the issue of gastric lymph flow dynamics and hopes to benefit the clinic. Methods We studied the dynamics of gastric lymph flow in 138 infants. Results The probability of lymph node metastasis in the 10th group was very high in proximal gastric cancer, and the possibility of lymph node metastasis was far lower in the 10th group when distal gastric cancer. Conclusion In combination with splenectomy for advanced gastric fundus cancer, combined splenectomy is not required for radical antral gastrectomy and supports splenectomy combined with splenectomy in patients with advanced gastric cancer, especially for focal lesions. This should be the case when the big curve side.