摘要
目的探讨进展期SiewertⅡ型胃食管结合部腺癌（AGEJ）淋巴结转移特点，为制定合理的手术方案提供临床依据。方法回顾性分析行胸腹两切口和胸腹腔两野淋巴结清扫术的86例进展期SiewertⅡ型AGEJ患者的临床资料，分析各组淋巴结的转移率以及胸腔转移的影响因素。结果本组86例AGEJ患者的淋巴结转移率为75．6％，其中胸腹腔均有转移的患者转移率为16．3％，单纯腹腔转移率为57．0％，单纯胸腔转移率为2．3％。在各组淋巴结中，第3、1、7、110、2和9组淋巴结的转移率分别为46．5％、41．9％、17．4％、14．0％、10．5％和5．8％。Logistic回归分析结果显示，SiewertⅡ型AGEJ胸腔淋巴结转移仅与脉管癌栓有关。结论SiewertⅡ型AGEJ患者腹腔淋巴结转移主要集中在近端胃周围和腹腔干动脉周围，而远端胃周和脾门周围转移率较低。第110组淋巴结转移率较高，胸腔转移仅与脉管癌栓有关。
Objective To explore the pattern of lymph node metastasis （LNM） in advanced Siewert type ]I adenocarcinoma of the gastroesophageal junction （AGEJ） in order to properly guide lymphadenectomy. Methods From January 2009 to Jun 2011, a total of 86 patients with advanced Siewert type II AGEJ underwent radical esophagogastrectomy by thoracic-abdominal incision and two-field lymphadenectomy. The clinical characteristics, pathologic features, LNM, and influence factor of thoracic metastasis were retrospectively analyzed. Results LNM was observed in 65 of the 86 cases （75.6%）. Simple abdominal lymph node metastasis was observed in 49 of the 86 cases （57.0%） , simple thoracic lymph node metastasis was 2. 3% , and thoracic-abdominal metastasis was 16. 3% , with a significant difference between the abdominal and thoracic metastatic patterns. LNM frequency was found in the lymph node groups No. 3, No. 1, No. 7, No. 110, No. 2 and No. 9 （from the highest to the lowest）. The incidences of those lymph node metastases were 46.5% , 41.9% , 17.4% , 14.0%, 10.5% , and 5.8%, respectively. Vascular tumor embolus was the only independent factor for thoracic lymph node metastasis. Conclusions Abdominal lymph node metastases of advanced Siewert type II AGEJ mainly occur around the proximal stomach and the coeliac trunk. The metastatic rate of distal stomach and splenic perihilar lymph nodes is low, but metastatic rate of the group No. 110 lymph nodes is high. The thoracic lymph node metastasis is only correlated with vascular tumor embolus.
出处
《中华肿瘤杂志》
CAS
CSCD
北大核心
2013年第4期288-291,共4页
Chinese Journal of Oncology
