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目的探讨进展期远端胃癌行D2根治术时No.12b组淋巴结清扫的必要性及可行性,及No.12b组淋巴结转移与临床病理因素的关系。方法回顾性收集60例进展期远端胃癌患者的病例资料,患者行D2或D2+根治术,并均加行No.12b组淋巴结清扫术。分析No.12b组淋巴结转移与临床病理因素的关系。结果全组无手术死亡病例,无严重并发症发生。60例患者中发现12例有No.12b组淋巴结转移,转移率为20.00%。其中BorrmannⅢ、Ⅳ型者No.12b组淋巴结转移率为31.25%(10/32),淋巴结转移N2～3期者为30.30%(10/33),肿瘤浸润T3～4期者为29.73%(11/37),明显高于BorrmannⅠ、Ⅱ型〔7.14%(2/28)〕,N0～1期〔7.41%(2/27)〕及T1～2期者〔4.35%(1/23)〕,P<0.05;No.12b组淋巴结转移与肿瘤的大小无关(P>0.05)。结论 No.12b组淋巴结清扫术对于进展期胃远端癌是必要且可行的,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 No.12b lymph node dissection in advanced distal gastric cancer undergoing D2 radical operation and the relationship between lymph node metastasis and clinicopathological factors in No.12b group. Methods The data of 60 patients with advanced gastric cancer were retrospectively collected. Patients underwent D2 or D2 radical mastectomy and were treated with No.12b lymph node dissection. Analysis of No.12b lymph node metastasis and clinicopathological factors. Results The whole group of patients without surgical death, no serious complications. Twelve of 60 patients were found to have No.12b lymph node metastasis with a metastasis rate of 20.00%. Among them, the rates of lymph node metastasis in No.12b group of Borrmann Ⅲ and Ⅳ type were 31.25% (10/32), those in N2 ~ 3 stage of lymph node metastasis were 30.30% (10/33) and those in T3 ~ 4 stage were 29.73% (11 / 37) was significantly higher than that of Borrmann Ⅰ, Ⅱ [7.14% (2/28)], N0_1 [7.41% (2/27)] and T1 ~ 2 [4.35% P <0.05; No.12b lymph node metastasis and tumor size has nothing to do (P> 0.05). Conclusion No.12b lymph node dissection is necessary and feasible for advanced gastric distal cancer, and its long-term effect needs to be further confirmed by a large sample of prospective studies.