保留胰腺和脾脏的胃癌根治性切除术及淋巴结功能性清扫

Radical resection of gastric carcinoma with pancreas and spleen preservation and functional cleaning of lymph nodes.

作者信息

Qin Huanlong, Lin Chaohong

机构信息

Department of Surgery, Shanghai Sixth People's Hospital, Shanghai 200233, China.

出版信息

Chin Med J (Engl). 2002 May;115(5):736-9.

PMID:12133545

Abstract

OBJECTIVE

To study the clinical value of radical resection of gastric carcinoma with pancreas and spleen preservation (PSP) and functional cleaning of lymph nodes (LNs) of the spleen hillus and along the splenic artery.

METHODS

Pancreas and spleen involvement was retrospectively reviewed among 439 cases of resectable carcinoma of the gastric cardia, gastric corpus and total stomach. During gastric surgery, 2 ml of methylene blue was injected into the subserosal space of the gastric cardia or corpus to observe the spread of lymphatic flow in 54 cases of gastric carcinoma. The metastatic rate of LNs in splenic hillus and along the trunk of the splenic artery (No10, No11), postoperative complications and survival rates were investigated in 63 gastric carcinoma patients that had received gastrectomy with pancreas and spleen preservation (PSP). These were compared with the pancreas preservation (PP) group and pancreas and spleen combined resection (PSR) group.

RESULTS

Among these 439 cases, only 25 cases were observed with direct invasion to the pancreas (5.7%), and 10 cases with direct invasion to the spleen (2.3%). After pathological examination of the pancreatic body and tail, we found 22 cases with pancreas and spleen combined resection, 4 cases (18.2%, 4/22) with direct invasion of the capsule and 2 with invasion to the superficial parenchyma (9.1%, 2/22), without metastasis to the lymph nodes within the pancreas and spleen. The metastatic rate of No10, No11 lymph nodes were 17.5% (11/63) and 19.1% (12/63) in the PSP group, 20.8% (45/216) and 25% (54/216) in the PP group, and 20% (6/30) and 23.3% (7/30) in the PSR group. There were no statistically significant differences (P > 0.05). Injection of methylene blue into the subserosal space of the stomach did not diffuse into the spleen or pancreatic parenchyma. Postoperative complications, diabetes and mortality in PSP (0%, 0%, 0%) were lower than in PP (4.2%, 0.9%, 0.9%) or PSR (40%, 10%, 3.3%). The 5-year survival rate (5-YSR) and 10-YSR in PSP (57.5%, 52.0%) were higher than in PSR (37.5%, 30.0%). Those patients with stage II and III(a) treated by PSP, improved markedly.

CONCLUSIONS

The surgical procedure of pancreas and spleen preservation for gastric cancer is a safe and organ function protected method. Postoperative complications were lower and survival rates were higher, the radicality was not reduced. These results indicate that PSP is preferred in patients with gastric carcinoma of stage II or III(a).

摘要

目的

探讨保留胰腺和脾脏（PSP）的胃癌根治术及脾门和脾动脉旁淋巴结功能性清扫的临床价值。

方法

回顾性分析439例可切除的贲门癌、胃体癌及全胃癌患者胰腺和脾脏受累情况。在胃癌手术中，向54例胃癌患者的贲门或胃体浆膜下间隙注射2ml亚甲蓝，观察淋巴液流动扩散情况。对63例行保留胰腺和脾脏的胃癌根治术（PSP）患者，研究脾门和脾动脉主干旁淋巴结（No10、No11）转移率、术后并发症及生存率，并与保留胰腺（PP）组和胰脾联合切除（PSR）组进行比较。

结果

439例患者中，仅25例（5.7%）观察到直接侵犯胰腺，10例（2.3%）直接侵犯脾脏。对胰体尾进行病理检查后，发现22例行胰脾联合切除，4例（18.2%，4/22）有包膜直接侵犯，2例（9.1%，2/22）侵犯至浅层实质，胰腺和脾脏内淋巴结无转移。PSP组No10、No11淋巴结转移率分别为17.5%（11/63）和19.1%（12/63），PP组分别为20.8%（45/216）和25%（54/216），PSR组分别为20%（6/30）和23.3%（7/30）。差异无统计学意义（P>0.05）。向胃浆膜下间隙注射亚甲蓝未扩散至脾脏或胰腺实质。PSP组术后并发症、糖尿病及死亡率（0%，0%，0%）低于PP组（4.2%，0.9%，0.9%）或PSR组（40%，10%，3.3%）。PSP组5年生存率（5-YSR）和10年生存率（10-YSR）（57.5%，52.0%）高于PSR组（37.5%，30.0%）。PSP治疗的Ⅱ期和Ⅲ（a）期患者改善明显。