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目的探讨胃癌腹主动脉旁淋巴结转移的规律和清扫术的适应症。方法对 D3加腹主动脉旁淋巴结廓清术 5 3例患者的临床资料进行回顾性分析。结果本组 16a2、16b1组淋巴结转移率 17% ,均为进展期胃癌 ,均有 N1 ～ N2 淋巴结转移。胃癌浸润深度达 T3、T4 者淋巴结转移率 2 1.5 % ,低分化型癌的淋巴结转移率为 2 2 .2 % ,癌灶直径≥ 5 cm的淋巴结转移率 2 5 .8% ,弥漫型胃癌患者淋巴结转移率更高达 42 .8%。结论胃癌浸润深度、癌肿组织学类型和分化程度、肿瘤部位、肿瘤大体类型、肿瘤大小等病理因素是预测腹主动脉旁淋巴结转移的主要根据 ,对高度怀疑或证实有 N1 ～ N2 淋巴结转移 ,浸润深度 T3、T4 ,进展期低分化型癌 ,癌灶直径≥ 5 cm,以及弥漫型胃癌 ,但无肝脏、腹膜等远处转移的胃癌患者尽可能行 D3加腹主动脉旁淋巴结廓清术。
Objective To investigate the rule of lymph node metastasis of abdominal aorta of gastric cancer and its indications for dissection. Methods The clinical data of 53 patients with D3 and abdominal para-aortic lymph node dissection were retrospectively analyzed. Results The group of 16a2,16b1 lymph node metastasis rate of 17%, are advanced gastric cancer, have N1 ~ N2 lymph node metastasis. The infiltration depth of gastric cancer reached T3 and T4, the rate of lymph node metastasis was 2.5%, the rate of lymph node metastasis of poorly differentiated carcinoma was 22.2%, the rate of lymph node metastasis of cancerous lesion ≥ 5 cm was 25.8% Lymph node metastasis rates were as high as 42.8%. Conclusions The depth of gastric cancer invasion, histological types and differentiation of cancer, pathological factors such as tumor location, tumor type and tumor size are the main evidences for predicting the para-aortic lymph node metastasis. Invasion depth T3, T4, advanced poorly differentiated carcinoma, cancer diameter ≥ 5 cm, and diffuse gastric cancer, but no liver, peritoneal distant metastasis of gastric cancer patients as much as possible with D3 plus para-aortic lymph node dissection.