[联合脾切除术治疗伴有第10组淋巴结转移的近端胃癌的疗效]

[Efficacy of combined splenectomy in proximal gastric cancer with No.10 lymph node metastasis].

作者信息

Wang Jia-bin, Huang Chang-ming, Lu Hui-shan, Zheng Chao-hui, Li Ping, Xie Jian-wei, Zhang Xiang-fu

机构信息

Department of Oncology, The Affiliated Union Hospital, Fujian Medical University, Fuzhou 350001, China.

出版信息

Zhonghua Wei Chang Wai Ke Za Zhi. 2009 Mar;12(2):121-5.

PMID:19296243

Abstract

OBJECTIVE

To explore the impact on prognosis of D(2) lymphadenectomy combined with splenectomy in patients of advanced proximal gastric cancer with No.10 lymph node metastasis.

METHODS

Clinical data of 216 patients of advanced proximal gastric cancer with No.10 lymph node metastasis undergone D(2) curative resection in our hospital from January 1980 to December 2002 were analyzed retrospectively. Among them, 73 underwent simultaneous splenectomy (splenectomy group), while 143 without splenectomy (spleen-preserving group). The 5-year survival rate, the mean numbers of dissected No.10 lymph nodes and metastatic No.10 lymph nodes, the complication morbidity and mortality were compared between the two groups.

RESULTS

The 5-year survival rates of splenectomy group and spleen-preserving group were 30.0% and 19.7% respectively, whose difference was significant(P<0.05). The mean numbers of dissected No.10 lymph nodes and metastatic No.10 lymph nodes in splenectomy group were significantly greater than those in spleen-preserving group(P<0.05). Splenectomy, invasion depth and gastrectomy type were independent prognostic factors. The survival rates of T(3) patients in splenectomy group and spleen-preserving group were 38.7% and 18.9% respectively, whose difference was significant (P<0.05). The survival rates of patients undergone total gastrectomy in splenectomy group and spleen-preserving group were 33.4% and 20.7% respectively, whose difference was significant (P<0.05). The complication morbidity and mortality in splenectomy group were 24.7% and 4.1%, while in spleen-preserving group were 17.5% and 3.5% respectively, whose differences were not significant(P>0.05).

CONCLUSIONS

Splenectomy is benefit for No.10 lymph node dissection in patients with advanced proximal gastric cancer. To improve the prognosis, total gastrectomy combined with splenectomy should be recommended for patients of T(3) proximal gastric cancer with No.10 lymph node metastasis. Simultaneous splenectomy dose not increase the complication morbidity and mortality.

摘要

目的

探讨D（2）淋巴结清扫联合脾切除术对伴有第10组淋巴结转移的进展期近端胃癌患者预后的影响。

方法

回顾性分析1980年1月至2002年12月在我院接受D（2）根治性切除术的216例伴有第10组淋巴结转移的进展期近端胃癌患者的临床资料。其中，73例行同期脾切除术（脾切除组），143例未行脾切除术（保脾组）。比较两组患者的5年生存率、第10组淋巴结清扫数目及转移淋巴结数目、并发症发生率及死亡率。

结果

脾切除组和保脾组的5年生存率分别为30.0%和19.7%，差异有统计学意义（P<0.05）。脾切除组第10组淋巴结清扫数目及转移淋巴结数目均显著多于保脾组（P<0.05）。脾切除术、浸润深度和胃切除类型是独立的预后因素。脾切除组和保脾组T（3）患者的生存率分别为38.7%和18.9%，差异有统计学意义（P<0.05）。脾切除组和保脾组全胃切除患者的生存率分别为33.4%和20.7%，差异有统计学意义（P<0.05）。脾切除组并发症发生率和死亡率分别为24.7%和4.1%，保脾组分别为17.5%和3.5%，差异无统计学意义（P>0.05）。