进展期胃癌行腹主动脉旁淋巴结清扫的疗效观察

・临床论著・

基金项目:中山大学“211工程”重点学科建设资助项目(98087)作者单位:510080广州,中山大学附属第一医院胃肠胰外科

进展期胃癌行腹主动脉旁淋巴结清扫的疗效观察

詹文华　何裕隆　郑章清　彭俊生　蔡世荣　马晋平

【摘要】　目的　评价进展期胃癌患者淋巴结清扫范围与生存率的关系。　方法　共施行进展期胃癌根治术158例,其中在D 2、D 2+或D 3的基础上再作腹主动脉旁淋巴结清扫(PALD 组)共73例,未作腹主动脉旁淋巴结清扫(非PALD 组)共85例。2组在年龄、性别、肿瘤部位、Borrmann 分型、肿瘤大小、组织学类型差异无显著性意义,而PALD 组的侵犯深度、淋巴结转移和临床病理分期均较非

PALD 组更晚期。　结果　PALD 组手术时间为(280±93)min ,非PALD 组为(245±91)min (P <0101)。输血量PALD 组为(693±324)ml ,非PALD 组为(460±375)ml (P <0101)。2组均无吻合口

瘘、胰瘘、腹腔脓肿及肠梗阻等并发症。除PALD 组腹泻发生率较高外,其他并发症2组差异无显著性意义。2组生存曲线、平均生存期、中位生存期的差异有显著性意义(P <0105),2组中淋巴结阴性、阳性患者的生存曲线、平均生存期、中位生存期差异亦有显著性意义(P <0105)。PALD 组腹主动脉旁淋巴结阴性、阳性患者的生存曲线、平均生存期、中位生存期差异有显著性意义(P <0105)。　结论　腹主动脉旁淋巴结清扫有助提高进展期胃癌患者生存期,且其病死率和并发症发生率与限制性手术并无明显差别。

【关键词】　胃肿瘤;　淋巴结切除术;　生存率

E ffectiveness of para 2aortic lymph node dissection for advanced gastric cancer ZHA N Wen 2hua ,HE Y u 2long ,ZHEN G Zhang 2qing ,PEN G J un 2sheng ,CA I S hi 2rong ,MA Jin 2ping.Depart ment of Gast rointestinopancreatic S urgery ,First A f f iliated Hospital ,S un Yat 2sen U niversity ,Guangz hou 510080,China

【Abstract 】　Objective To assess whether any correlation exists between survival and the extent of lymph 2node dissection.　Methods D 2,D 2+or D 3radical resection was performed on 158patients with advanced gastric cancer.Among them ,73were subjected to para 2aortic lymph node dissection ,(PALD group ),and the other 85were not subjected to the operation (non 2PALD group ).There was no significant difference in age ,gender ,site of tumors ,type of Borrmann and histology between the two groups.The PALD group showed more advanced diseases in term of tumor invasion ,lymph node metastasis and clinicopathological stage.　R esults Average operation time was longer in the PALD group than in the non 2PALD group[(280±93)min VS.(245±91)min ,(P <0101)].Blood transfusion volume was (693±324)ml in the PALD group ,and (460±375)ml in the non 2PALD group (P <0101).No anastomotic leaks,pancreatic fistula ,abdominal abscess and ileus were observed in both groups.No significant complications were found except for a higher incidence of diarrhea in the PALD group.Significant difference was found in survival curve ,mean and median survival time between the two groups.The difference in survival was also found between patients with positive and negative lymph node metastasis in the PALD and non 2PALD groups.Again ,there was significant difference in survival between positive and negative No.16lymph node in the PALD group.　Conclusion Para 2aortic lymph node dissection offers a significant survival benefit to curable patients with advanced gastric cancer.It is similar to limited lymphadenectomy in morbidity and mortality.

【K ey w ords 】　Stomach neoplasms ;　Lymph node excision ;　Survival rate

日本等东亚国家认为,广泛的淋巴结清扫(extended lymph node dissection ,ELND )能提高胃

癌患者的生存率,主张把D 2作为标准的手术常规,

在合适病例,切除范围可进一步扩大到D 3、D 4。欧美有些学者则认为,ELND 提高生存率是由于分期移动现象(stage migration phenomenon )所致。日本的结果在欧洲的几项前瞻随机性对照研究中未能获