目的　研究进展期胃癌 (AGC)腹主动脉旁淋巴结 (16LN)转移情况和D4式手术的适应证。方法　AGC 5 3例 ,随机分为D2 廓清术组 (n =32 )及D4廓清术组 (n =2 1) ;分析16组淋巴结转移与临床病理的关系 ,比较D4和D2 式廓清术手术创伤程度、手术并发症与死亡率 ,术后生活质量 (QOL)以及患者的预后。结果　 2 1例行D4式廓清术者的 16LN转移率为 2 8 6 %。与胃癌侵犯或穿透浆膜深度及N2 转移与Ⅲ Ⅳa期胃癌有密切相关性 (P <0 .0 5 )。与D2 组比较 ,D4廓清术导致手术创伤程度增加 ,但手术并发症率、死亡率及平均住院天数无明显增加 ,术后QOL无明显差异。结论　D4廓清术对AGC是安全、合理和可行的。其适应证为 :①癌肿侵及浆膜层 ;②Ⅲ ,Ⅳa期胃癌 ;③N2 淋巴结阳性者 ;④ 16LN有转移者 Objective To study the metastasis of para-aortic lymph nodes (16LN) in advanced gastric cancer (AGC) and indications of D4 surgery. MethodsAGCs were randomly divided into D2 clearance group (n = 32) and D4 dissection group (n = 21). The relationship between lymph node metastasis and clinicopathology was analyzed. The D4 and D2 dissection were compared. Degree, surgical complications and mortality, postoperative quality of life (QOL), and prognosis of the patient. Results The 16LN metastasis rate of 21 patients undergoing D4 dissection was 286%. There was a close relationship between gastric cancer invading or penetrating serosal depth and N2 metastasis and III-IVa gastric cancer (P < 0.05). Compared with group D2, D4 clearance resulted in increased surgical trauma, but there was no significant increase in complication rate, mortality, and average hospital stay. There was no significant difference in postoperative QOL. Conclusion D4 dissection is safe, reasonable and feasible for AGC. Its indications are: 1 cancer invasion and serosa; 2 III, IV a gastric cancer; 3N2 lymph node positive; 4 16LN metastasis