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目的 :研究胃癌脾门淋巴结 (No .10 )和脾动脉周围淋巴结 (No .11)转移规律 ,进一步探讨No .10和 11清扫的必要性和方法。方法 :1991年～ 2 0 0 0年 132例行全胃切除 ,D2以上淋巴结清扫的胃癌患者 ,回顾性研究临床病理资料 ,包括性别、年龄、肿瘤部位、大小、浸润深度、病理类型、其他淋巴结转移等对No .10和 11转移的影响 ,比较全胃切除和全胃联合脏器切除的并发症发生率。结果 :胃癌具有较高的No .10或 11淋巴结转移率 (18.9% ) ,Logistic回归分析表明 ,胃癌部位、病理类型、浸润深度和大小弯淋巴结转移五项临床病理指标影响No .10和 11转移率。联合脏器切除的并发症发生率 (32 % )明显高于单纯全胃切除 (11.2 % ) ,联合胰体尾切除增加膈下脓肿发生率 ,而脾切除并不增加全胃切除的危险性。结论 :No .10和 11在胃癌有较高的转移率和特定的转移规律 ,预防性和治疗性的清扫实属必要 ,联合左侧胰体尾加脾切除增加手术危险性 ,应严格掌握的适应证。而保留胰腺 ,切除脾血管和脾清扫No .10和 11淋巴结合理可靠。
Objective: To study the metastasis of splenic lymph nodes (No. 10) and peripheral lymph nodes (No. 11) in gastric cancer and to explore the necessity and methods of No. 10 and 11 dissection. METHODS: A total of 132 gastric cancer patients who undergone total gastrectomy and D2 or more lymph node dissection from 1991 to 2000 were retrospectively studied. The clinical and pathological data including gender, age, tumor location, size, depth of invasion, pathological type, other lymph nodes Metastasis and so on No .10 and 11 metastasis, compared the total gastrectomy and total gastrectomy combined with the incidence of complications. Results: Gastric cancer had higher No .10 or 11 lymph node metastasis rate (18.9%). Logistic regression analysis showed that gastric cancer location, pathological type, depth of invasion and size of benign and malignant lymph nodes metastasis affected No .10 and 11 metastasis rate. Combined organ resection complications (32%) were significantly higher than simple total gastrectomy (11.2%), combined with pancreatic tail resection increased the incidence of subphrenic abscess, splenectomy does not increase the risk of total gastrectomy. Conclusion: No.10 and 11 in gastric cancer have a higher rate of transfer and specific metastasis, prophylactic and therapeutic dissection is necessary, combined with the left pancreatic tail plus splenectomy increases the surgical risk should be strictly controlled Indications. While preserving the pancreas, resecting splenic vessels and splenectomy No .10 and 11 lymph node therapy is reliable.