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目的研究早期胃癌生物学特性和长期生存有助于术前评估淋巴转移程度和范围,从而探讨缩小手术的合理适应证。方法分析比较520例早期胃癌的癌肿胃壁浸润深度、癌肿大小以及是否伴发溃疡、大体类型及组织学类型对淋巴转移和长期生存的影响。结果黏膜内(m)癌和黏膜下层(sm)癌的淋巴转移率分别为1.5%和22.0%。在m癌中,除Ⅱc或Ⅱc加Ⅲ外,其它大体类型均无淋巴转移,小于2cm者亦无淋巴转移。sm癌和伴发溃疡的m癌易发生淋巴转移。组织学类型的不同并不明显影响淋巴转移。m癌和sm癌的10年生存率分别为84.4%和80.0%。结论影响淋巴转移的高危因素有肿瘤侵及黏膜下层、肿瘤大于2cm并伴有溃疡,以及Ⅱc或Ⅱc加Ⅲ型,故这些病例应慎行各种缩小手术,尤其是内镜下切除术。确定缩小手术适应证的前提,是术前对于浸润深度高精度的确定和术中病理学的准确诊断。
Objective To study the biological characteristics and long-term survival of early gastric cancer in order to help assess the extent and extent of lymphatic metastasis before surgery, so as to explore the reasonable indications for reducing surgery. METHODS: The depth of gastric cancer infiltration, the size of cancer, and the presence or absence of ulceration, gross type, and histological type of cancer in 520 cases of early gastric cancer were analyzed and compared for lymph node metastasis and long-term survival. Results The lymphatic metastasis rate of intramural (m) cancer and submucous (sm) cancer was 1.5% and 22.0%, respectively. In the m cancer, except for IIc or IIc plus III, no lymph node metastasis was found in any of the general types, and there was no lymphatic metastasis in less than 2 cm. Sm cancer and associated ulcers of m cancer prone to lymph node metastasis. The difference in histological type does not significantly affect lymphatic metastasis. The 10-year survival rates of m and sm cancers were 84.4% and 80.0%, respectively. Conclusion The high-risk factors affecting lymphatic metastasis include tumor invading the submucosa, tumors larger than 2cm with ulcers, and IIc or IIc plus type III. Therefore, these patients should be cautious of various reduction operations, especially endoscopic resection. The precondition for the determination of surgical indications is to determine the accuracy of invasive depth before surgery and the accurate diagnosis of intraoperative pathology.