摘要
目的 探讨残胃癌淋巴结转移规律及其合理的根治术式。方法 回顾性分析我院从 1979年 3月至 1997年 9月收治的 6 4例残胃癌患者的淋巴结转移规律、手术方式及其疗效。结果 本组残胃癌患者 6 4例 ,占同期手术病人的 2 1%。其中包括治愈性切除者 30例 ,其淋巴结转移率分别为第 1组 5 9 1% (13/ 2 2 )、2组 33 3% (6 / 18)、3组 80 0 % (2 4/ 30 )、4组 46 7% (7/ 15 )、7组 2 5 0 %(3/ 12 )、8组 36 4% (4 / 11)、9组 40 0 % (6 / 15 )、10组 6 0 0 % (6 / 10 )、11组 72 3% (8/ 11)、12组 33 3 %(12 / 36 )、13组 11 1% (4 / 36 )、16组 2 1 4% (3/ 14)、111组 5 0 % (1/ 2 )及空肠系膜淋巴结转移率 16 7%(3/ 18)。本组病例中仅行开腹探查的 6例患者均于 1年内死亡 ,而治愈性切除病例 (n =30 )的 1、3、5年生存率明显好于非治愈性切除病例 (n =2 8)〔10 0 %对 82 1% ,73 3 %对 32 1% ,36 7%对 3 6 %(χ2 值分别为 10 5 6、11 6 7、7 76 ,P <0 0 1)〕。结论 ①B Ⅰ式重建残胃癌病例的切除范围包括胃十二指肠吻合口 ,并清除第 1、2、3、4、7、8、9、10、11组淋巴结 ,必要时一并清除第 12、14、13组淋巴结 ;②B Ⅱ式重建残胃癌病例的切除范围包括胃肠吻合口左右的口、肛侧空肠各 10cm ,同?
Objective To investigate the pattern of lymph node metastasis and optimal surgery for patients with gastric stump cancer.[WT5”HZ] Methods[WT5”BZ] Metastasis of the lymph node, operative procedure and prognosis of patients with gastric stump cancer during March 1979 and December 1997 were retrospectively analyzed.[WT5”HZ] Results[WT5”BZ] 64 patients (2.1%) with gastric stump cancer were enrolled in this study during the period, including 30 patients undergoing curative gastrectomy, and the metastatic rates of lymph node were as following: 59 1%(13/22) in right cardia node (group 1), 33 3% (6/18) in left cardia (group 2), 80 0% (24/30) in lesser curvature (group 3), 47% (7/15) in greater curvature (group 4), 25%(3/12) in nodes along the root of left vessel (group 7), 36 4% (4/11) in nodes along common hepatic artery (group 8), 40% (6/15) along celiac artery (group 9), 60% (6/10) in splenic hilum (group 10), 73% (8/11) along splenic artery (group 11), 33% (12/36) within hepatoduodenal ligament (group 12), 12%(4/36) in retropancreatic region (group 13), 21% (3/14) in para aortic area (group 16), 50% (1/2) in supra diaphragm (group 111),and 16 7% (3/18) in jejunal mesentery,respectively All six patients undergoing laparotomy only died within one year, and the 1,3,5 year survival rates of patients ( n =30) with curative gastrectomy were significantly better than those of patients ( n =28) with palliative gastrectomy 〔100% (30/30) v s 82.1%(18/28), 73 3% (22/30) v s 32 1% (7/28) and 36 7%(11/30) v s 3 6% (1/28), respectively〕 (χ 2=10 56, 11 67 and 7 76, P <0 01, respectively).[WT5”HZ] Conclusions[WT5”BZ] ①Rational surgical procedure for Billroth Ⅰgastric stump cancer patients consists of removal of the gastroduodenostomy and lymph nodes of groups 1, 2, 3, 4, 7, 8, 9, 10, and groups 12, 14 and 13, if necessary. ②Billroth Ⅱgastric stump cancer patients need to remove 10 cm of jejunum distal and proximal to the original anastomosis, to dissect lymph node in the jejunal mesentery, in addition to dissect the lymph nodes to be removed as Billroth Ⅰstump gastric cancer patients. ③gastric stump cancer patients with esophageal involvement,while the lesion is still resectable, need combined thoracolaparotomy and removal of the lymph nodes of group19, 20, 108, 110 and 111, in addition to procedure ① and/ or ②.④ therefore, patients with stump gastric cancer can gain better prognosis by undergoing curative resection.
出处
《中华普通外科杂志》
CSCD
2000年第7期423-425,共3页
Chinese Journal of General Surgery
关键词
胃残端癌
外科手术
肿瘤转移
淋巴结转移
Carcinoma
Gastric stump
Lymph node
Surgery, operative
Neoplasm,metastatic
