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目的探讨胃下部癌淋巴结转移的规律及其指导合理清除淋巴结的意义。方法通过185例D2以上手术切除的转移淋巴结资料,对各站、各组转移淋巴结进行相关性分析。结果(1)胃下部癌淋巴结转移常分布在第Ⅰ、Ⅱ站各组淋巴结,其中No.6最多,No.12～14v各组亦有一定的转移率;(2)第Ⅰ站各组淋巴结转移后,易发生第Ⅱ站No.7及No.8a淋巴结转移;(3)第Ⅱ、Ⅲ站中存在两个中间淋巴结群,一个由No.1、No.7及No.9组成,另一个由No.8a及No.12组成。No.3、No.4d、No.6及No.4d可分别预测No.8a、12群及No.1、7、9群转移;(4)跳跃转移占10.3%,其中超越第Ⅱ站者4例。结论(1)胃下部癌根治术应强调扩大清除淋巴结,范围至少达D2,并应注意彻底清除No.6、No.7及No.8a;(2)日本胃癌处理规约第12版规定的胃下部癌D2清除范围欠充分,部分病例需清除No.12～14v;(3)中间淋巴结群No.8a、12群及No.1、7、9群应整体清除,No.3、No.4d、No.6术中活检,预测它们的转移有一定的临床指导价值;(4)D2清除术的有效性受跳跃转移的干扰。
Objective To investigate the regularity of lymph node metastasis in gastric cancer and its significance in guiding the proper removal of lymph nodes. Methods The data of 185 cases of metastatic lymph nodes surgically resected from D2 were analyzed. The correlations of metastatic lymph nodes among different stations and groups were analyzed. Results (1) Lymph node metastasis of gastric cancer usually distributed in lymph nodes of group Ⅰ and Ⅱ, with the largest number of No.6 and the metastasis rates of No.12 ~ 14v in each group. (2) After the transfer, prone to Station No.7 and No.8a lymph node metastasis; (3) there are two intermediate lymph node II, Ⅲ stations, one by No. 1, No.7 and No.9, and the other One consists of No. 8a and No.12. No.3, No.4d, No.6 and No.4d were predicted No.8a, 12 groups and No.1,7,9 group transfer respectively; (4) Jump transfer accounted for 10.3%, which exceeded the second station 4 cases. Conclusions (1) Radical treatment of gastric cancer should emphasize the expansion of lymph nodes, the range of at least D2, and should pay attention to the complete removal of No.6, No.7 and No.8a; (2) Japanese stomach cancer protocol twelfth edition of the stomach Lower part of the D2 clearance of less than sufficient, in some cases need to clear No.12 ~ 14v; (3) the middle of the lymph node group No.8a, 12 and No.1, 7, 9 group should be completely cleared, No.3, No.4d , No.6 intraoperative biopsy, predict their metastases have some clinical value; (4) the effectiveness of D2 removal by jumping interference.