胃癌孤立性淋巴结转移与临床病理的关系

Relationship between clinicopathological factors and pattern of solitary lymph node metastasis in gastric cancer

关键词:  胃癌  淋巴结转移  前哨淋巴结

Key words:  stomach carcinoma  lymph node metastasis  sentinel lymph node

摘要:

［目的］探讨胃癌孤立性淋巴结转移规律，为进一步前瞻性检测胃癌前哨淋巴结并指导胃癌淋巴结清扫范围提供理论依据。［方法］ 回顾性分析76例发生孤立性淋巴结转移的胃癌病例的临床病理资料，比较跳跃性淋巴结转移和非跳跃性淋巴结转移两组间的临床病理特征。［结果］非跳跃性转移组55例（72.4%），以第3、4组淋巴结转移常见；跳跃性转移组21例（27.6%），以第7组转移常见。位于第2站者19例，位于第3站者2例（均为第12组）。跳跃性淋巴结转移与年龄和淋巴结检出数有显著相关性，P≤0.05。［结论］ 胃癌孤立性淋巴结转移以胃周为主。跳跃性淋巴结转移以胃左动脉周围淋巴结多见，且与年龄和淋巴结检出数有关。D₂ 根治术加第12组淋巴结清扫有利于预防跳跃性转移灶的残留。

Abstract:

［Objective］ To explore the pattern of solitary lymph node(LN) metastasis in gastric cancer for directing the extent of lymphadenectomy and applying the concept of sentinel LN biopsy. ［Methods］ A total of 76 patients with gastric cancer with solitary LN metastasis were analyzed retrospectively. These patients were divided into 2 groups with or without skipping LN metastasis. Clinicopathological factors were compared between these two groups. The precise location of the metastatic LN and its correlation with the site of primary tumor were studied. ［Results］ The rate of non-skipping metastasis and skipping metastasis in the series was 72.4% (55/76) and 27.6% (21/76) respectively. In no-skip metastasis group, solitary lymph node metastasis was usually found in No 3 and No 4 groups of lymph nodes, while No 7 group was commonly involved in cases of skip metastasis. In 21 cases with skip metastasis, there were 19 cases in the N₂ nodes and 2 cases in N₃ nodes (both in No 12 group). A significant difference between two groups was observed in the ages and the total number of retrieved nodes, P≤0.05. ［Conclusions］ Solitary LN metastasis is mainly located in the perigastric region, while skipping metastasis may be correlated with the ages and the total number of retrieved nodes. Radical resection with D₂ and No.12 lymphadenectomy may decreases the residual rate of jumping node involvement.