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作者报告了胃癌R_2、R_3手术309例中,发生断端癌残留17例(5.5%),胃周淋巴结跳跃性转移21例(6.8%)及胃浆膜受侵106例(34.7%)。手术后因吻合部位及转移淋巴结癌残留复发,尤其腹膜种植性转移,影响手术疗效。癌残留主要发生在胃上部癌的上切缘及胃下部癌的下切缘;发生在7、8a、12组淋巴结跳跃性转移占80%;原发癌肿＞5.0cm、BorrmannⅢ、Ⅳ型浸润癌、弥漫性生长方式的未分化型癌、淋巴管癌栓阳性及TNMⅢ、Ⅳ期胃癌,易发生断端癌残留、淋巴结跳跃性转移及胃浆受侵癌细胞向腹腔脱落种植。对此,作者提出术前和术中相应的诊断及防治对策。
The authors reported that in 309 cases of gastric cancer R_2 and R_3, 17 cases (5.5%) had stump cancer residuals, 21 cases (6.8%) of peripheral lymph node metastases and 106 cases (34.7%) of gastric serosa invaded. After surgery, the recurrence of residual tumors and metastasis of lymph node metastasis, especially peritoneal implant metastasis, affect the surgical outcome. The cancer residues mainly occurred in the upper margin of upper stomach cancer and the lower margin of the lower stomach cancer; 80% occurred in the metastasis of lymph nodes in 7, 8a, 12; the primary cancer was> 5.0cm, Borrmann III, IV invasive carcinoma. Diffuse growth of undifferentiated carcinoma, lymphangioma thrombus positive and TNM III, IV gastric cancer, prone to the occurrence of stump cancer, lymph node skipping metastasis and gastric cancer invading cancer cells to the abdominal cavity planting. In this regard, the author proposed a corresponding preoperative and intraoperative diagnosis and prevention strategies.