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对认为可治愈胃癌病人的唯一治疗选择是手术,但对于淋巴结切除的范围意见不一,即仅限于胃周淋巴结切除(D_1),还是扩展至胃周以外的区域性淋巴结切除(D_2)?荷兰专家应用多中心随机比较方法研究了D_1和D_2方式的后果.D_1组513例,其中380例有治愈性切除的可能,D_2组483例,其中331例有治愈性切除的可能.平均年龄分别为64.9岁和63.1岁.50%以上肿瘤位于胃远端,因而最常见的手术方式是胃远端切除术,D_2组因技术需要均做了脾切除和胰腺切除术.D_2组术后死亡率明显高于D_1组,分别为10%和4%,P=0.004.D_2组中并发症发生率、再手术率也较高,术后平均住院日较长.D_1组并发症发生率为25%,D_2组为43%,D_1组再手术率8%,D_2组18%,D_1组术后平均住院日7—143天,D_2组7～277天.最常见的出血、切口感染等并发症D_2组比D_1组高2倍以上,但吻合口漏和腹腔内感染差异最明显,D_1组吻合口漏16例(4%),D_2组30例(9%),D_1组腹腔内感染30例(8%),D_2组55例(17%).
The only treatment option considered to be curable for gastric cancer patients is surgery, but the scope of lymph node dissection is not the same, that is, limited to the lymph node dissection (D_1), or extended to the regional lymph node dissection (D_2) outside the stomach? The experts used a multi-center randomized comparison method to study the consequences of the D_1 and D_2 modes. Of the 513 patients in the D_1 group, 380 patients had the potential for curative resection and 483 patients in the D_2 group, of whom 331 had curative resection. The average age was 64.9 years old and 63.1 years old. More than 50% of the tumors were located in the distal part of the stomach. Therefore, the most common surgical method was distal gastrectomy. D_2 group had splenectomy and pancreatectomy for technical reasons. The postoperative mortality was significant in the D_2 group. The incidence of complications and reoperation in the P=0.004.D_2 group was higher than that in the D_1 group, which was 10% and 4%, respectively. The average length of hospital stay was longer. The incidence of complications in the D_1 group was 25%. 43% in D_2 group, 8% in D_1 group, 18% in D_2 group, 7-143 days in D_1 group, and 7-277 days in D_2 group. The most common complications such as bleeding and incision infection were in group D_2. It was more than 2 times higher than D_1 group, but the difference between anastomotic leakage and intra-abdominal infection was most obvious. D_1 group had 16 anastomotic leaks (4%), D_ Twenty patients (9%) in the two groups, 30 patients (8%) in the D_1 group with intraperitoneal infection and 55 patients (17%) in the D_2 group.