Chernousov A F, Chernousov F A, Selivanova I M
Khirurgiia (Mosk). 2004(7):4-8.
Results of radical surgical treatment of 86 patients with early cancer of the stomach are analyzed. Among revealed macroscopic types of early cancer of the stomach (B0), type I (elevated) was seen in 26 (31%) patients, type IIa (superficial raised) - in 8 (9%), type IIb (superficial plane) - in 7 (8%), type IIc (superficial excavated) - in 20 (23%), type III (ulcerated) - in 25 (29%) patients. Adenocarcinoma was the prevalent tumor - 84 (98%) patients, in 1 (1%) case undifferentiated cancer was revealed and in 1 (1%) - carcinoid tumor. Tumor invasion was limited by mucosa in 49 (57%) patients, in submucosa - in 37 (43%). Metastases to lymph nodes were diagnosed in 4 (5%) patients. Subtotal proximal resection performed in 6 patients, subtotal distal resection - in 60, gastrectomy - in 20 patients. Lymphadenectomy corresponded to D1 in 30 cases, to D2 - in 51, to D3 - in 5 cases. Complications after surgery were seen in 21 (24%) patients. Cancer in the gastric stump was diagnosed in 3 (4%) patients 2, 4 and 6 years after primary subtotal distal resection of the stomach with D1 lymphadenectomy. All these patients underwent extirpation of gastric stump. Radical surgery for early cancer of the stomach must include extended lymphadenectomy D2 or more.
分析了86例早期胃癌患者的根治性手术治疗结果。在已发现的早期胃癌（B0）宏观类型中，I型（隆起型）见于26例（31%）患者，IIa型（浅表隆起型）见于8例（9%），IIb型（浅表平坦型）见于7例（8%），IIc型（浅表凹陷型）见于20例（23%），III型（溃疡型）见于25例（29%）患者。腺癌是主要肿瘤类型——84例（98%）患者，1例（1%）为未分化癌，1例（1%）为类癌肿瘤。49例（57%）患者肿瘤侵犯局限于黏膜层，37例（43%）侵犯至黏膜下层。4例（5%）患者诊断有淋巴结转移。6例行近端胃次全切除术，60例行远端胃次全切除术，20例行胃切除术。30例患者的淋巴结清扫相当于D1，51例相当于D2，5例相当于D3。21例（24%）患者术后出现并发症。在初次远端胃次全切除并D1淋巴结清扫术后2年、4年和6年，3例（4%）患者被诊断为残胃癌。所有这些患者均接受了残胃切除。早期胃癌的根治性手术必须包括扩大的D2或更广泛的淋巴结清扫。
