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目的探讨进展期胃癌门静脉周围淋巴结(No12p LN)清扫的必要性、可行性及其与转移和临床病理因素的关系。方法将进展期胃癌病例51例分为2组,(1)研究组30例,行D2或选择性D3根治术,外加门静脉周围淋巴结(No12p LN)清扫。分析门静脉周围淋巴结(No12p LN)转移与临床病理因素的关系;(2)对照组,21例。行D2或选择性D3根治术,但均未行No12p LN(门静脉后淋巴结)清扫。比较研究组与对照组的平均手术时间,平均术中出血量。结果研究组30例患者共检查552个淋巴结,平均每例清扫18.4个淋巴结,发现有112个淋巴结发生转移,转移度为21.24%;30例中发现4例No12p LN转移,转移率为13.33%,其中BorrmannⅢ,Ⅳ型No12 LN转移率为16.67%,N2-3期为25%,T3-4者为16.67%,肿块大于4 cm者淋巴结转移率为33.33%;No12p淋巴结转移率在BorrmannⅢ,Ⅳ型,N2-3期,T3-4及肿块大于4 cm者中明显高于BorrmannⅠ,Ⅱ型(0%),N0-1期(0%),T1-2(0%),肿块小于4 cm(0%)(均P<0.05),且No12p淋巴结的转移与No5淋巴结转移之间存在相关性;胃体癌及肿块超过1/3胃区域的胃癌亦有较高No12p LN转移率;组织分型与No12pLN转移无明显关系。两组间除手术时间研究组长于对照组外(P<0.05),平均术后住院时间、平均术中出血量均无显著性差异(P>0.05);术后并发症分别为2例(6.67%),3例(14.29%)(P(0.05),均无严重并发症发生。两组均无死亡病例。结论 No12p LN清扫术对于部分进展期胃癌是可行且有一定临床意义的。其远期效果有待大样本的前瞻性研究进一步证实。
Objective To investigate the necessity and feasibility of dissecting portal vein lymph nodes (No12p LN) in advanced gastric cancer and its relationship with metastasis and clinicopathological factors. Methods Fifty-one patients with advanced gastric cancer were divided into two groups. (1) 30 patients in the study group underwent D2 or selective radical mastectomy combined with No12p LN dissection. The relationship between lymph node metastasis (No12p LN) and clinicopathological factors was analyzed. (2) The control group, 21 cases. Line D2 or selective D3 radical surgery, but none of No12p LN (portal vein lymph node) cleaning. The average operation time and average blood loss of the study group and the control group were compared. Results A total of 552 lymph nodes were examined in 30 patients in the study group, with an average of 18.4 lymph nodes dissected per case. A total of 112 lymph nodes were found with a metastasis rate of 21.24%. Four cases of No12p LN metastasis were found in 30 cases, with a metastatic rate of 13.33% The No12 LN metastasis rate was 16.67%, N2-3 stage was 25%, T3-4 was 16.67%, and the rate of lymph node metastasis was 33.33% in Borrmann Ⅲ and Ⅳ tumors. No12p lymph node metastasis rate was found in Borrmann Ⅲ and Ⅳ (0%), N0-1 (0%) and T1-2 (0%) in patients with N2-3, T3-4 and tumors larger than 4 cm were less than 4 cm 0%) (all P <0.05). No correlation was found between No12p lymph node metastasis and No5 lymph node metastasis. There was also a higher No12p LN metastasis rate in gastric cancer and gastric cancer with more than 1/3 gastric mass. No significant correlation with No12pLN metastasis. There was no significant difference between the two groups (P> 0.05), the average length of postoperative hospital stay and mean blood loss (P> 0.05). The postoperative complications were 2 cases (6.67 %) And 3 cases (14.29%) (P <0.05), no serious complication occurred.No deaths were found in both groups.Conclusion No12p LN dissection is feasible and clinically significant for some advanced gastric cancer. Long-term results need to be further confirmed by prospective studies of large samples.