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目的:探讨进展期胃癌脾门淋巴结(10组)转移的相关临床病理因素。方法:回顾分析了(2008-2011年)75例胃癌根治术伴10组淋巴结切除的进展期胃癌病例。分析了临床病理学因素和10组淋巴结转移的相关性。结果:本研究结果提示10组淋巴结转移的阳性率为52%。胃下部癌的转移率(20%)相对较低(P=0.000),大弯侧肿瘤的转移率高达76.2%。病灶的侵润深度及病理TNM分期与10组淋巴结阳性率密切相关,组织学类型或分化程度与10组淋巴结转移无统计学相关。病灶小于3 cm病例的10组淋巴结转移的阳性率为0%,而大于9 cm或Borrmann-IV的肿瘤患者的10组淋巴结转移的阳性率为100%。结论:10组淋巴结转移的高危因素包括:1.中上部胃癌;2.肿瘤位于胃大弯侧;3.大于3 cm;4.侵达胃壁浆膜层。含以上高危因素的进展期胃癌根治手术中,建议常规行术中快速冰冻检查10组淋巴结是否存在转移;含2个以上高危因素的进展期胃癌建议行脾切除术,或如果技术条件具备应行保留脾的10组淋巴结清扫术以便最终获得R0切除。
Objective: To investigate the clinicopathological factors related to the metastasis of splenic lymph nodes (10 groups) in advanced gastric cancer. Methods: A retrospective analysis was performed on 75 cases of advanced gastric cancer resected with radical lymphadenectomy undergoing radical gastrectomy (2008-2011). The correlation between clinicopathological factors and lymph node metastasis was analyzed. Results: The results of this study suggest that the positive rate of lymph node metastasis in 10 groups was 52%. Metastases (20%) in lower gastric cancer are relatively low (P = 0.000), and the metastatic rate in the greater curvature side is as high as 76.2%. The depth of invasion and the TNM stage of the pathology were closely related to the positive rate of lymph node in 10 groups. There was no significant correlation between histological type or degree of differentiation and lymph node metastasis in 10 groups. The positive rate of 10 lymph node metastases was 0% in those less than 3 cm and 100% in 10 lymph node metastases of tumors larger than 9 cm or Borrmann-IV. Conclusion: The 10 risk factors of lymph node metastasis include: 1. Middle-upper gastric cancer; 2. The tumor is located on the greater curvature side of the stomach; 3. Greater than 3 cm; 4. Invasion of the gastric wall serosal layer. In the radical surgery of advanced gastric cancer with the above risk factors, it is recommended that routine operation should be performed to detect the presence or absence of metastasis of 10 lymph nodes in the group. Advanced gastric cancer with 2 or more risk factors is recommended for splenectomy or if the technical conditions are appropriate Ten splenic lymph nodes were retained for final R0 resection.