胃癌手术中淋巴结清扫的三步法：单中心 120 例经验。

Three-step method for lymphadenectomy in gastric cancer surgery: a single institution experience of 120 patients.

机构信息

Department of General Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.

出版信息

J Am Coll Surg. 2011 Feb;212(2):200-8. doi: 10.1016/j.jamcollsurg.2010.09.019.

DOI:10.1016/j.jamcollsurg.2010.09.019

PMID:21276533

Abstract

BACKGROUND

Gastric cancer is one of the most common malignancies and a leading cause of cancer death. Complete resection is still the only treatment to offer a cure for patients with gastric cancer. Lymphadenectomy is the most important part of curative resection, but lymphadenectomy is also very difficult in gastric cancer surgery. The aim of this study was to report our 3-step method for lymphadenectomy and clarify its safety and value in gastric cancer.

STUDY DESIGN

A total of 120 consecutive patients underwent our 3-step method for lymphadenectomy at the Second Affiliated Hospital Zhejiang University College of Medicine between February 2006 and July 2007. The main surgical procedure was performed from right to left and from caudal to cranial. Clinical factors, surgical variables, postoperative morbidity, and hospital (30-day) mortality were analyzed retrospectively.

RESULTS

Total gastrectomy was performed in 41 patients; combined adjacent organ resection was performed in 9 patients. The mean operation time was 201.8 minutes, and the mean blood loss was 376.7 mL. The median postoperative hospital stay was 14.9 ± 4.3 days. A total of 3,569 lymph nodes (LNs) were removed and examined, and 2,879 were negative. More than 15 LNs were examined in all 120 patients. The median number of examined LNs was 29 (range 17 to 64; mean 29.7 ± SD 9.6) per patient, and the median number of positive LNs was 5 (range 0 to 37; mean 5.8 ± SD 7.1) per patient. The overall incidence of postoperative complications was 10.8%, and the rate of hospital death was 0%. The median follow-up period for those patients was 34.3 months (range 10 to 53 months), and the overall 3-year survival rate was 40.6%.

CONCLUSIONS

The 3-step method for lymphadenectomy is easy to perform and is a safe and useful procedure for gastric cancer surgery.

摘要

背景

胃癌是最常见的恶性肿瘤之一，也是癌症死亡的主要原因。完全切除仍然是治愈胃癌患者的唯一治疗方法。淋巴结清扫是治愈性切除的最重要部分，但在胃癌手术中淋巴结清扫也非常困难。本研究旨在报告我们的三步法淋巴结清扫术，并阐明其在胃癌中的安全性和价值。

研究设计

2006 年 2 月至 2007 年 7 月，浙江医科大学第二附属医院连续 120 例患者采用三步法淋巴结清扫术。主要手术程序从右到左，从尾到头进行。回顾性分析临床因素、手术变量、术后并发症和住院（30 天）死亡率。

结果

41 例患者行全胃切除术；9 例患者行联合相邻器官切除术。手术时间平均为 201.8 分钟，出血量平均为 376.7 毫升。术后中位住院时间为 14.9±4.3 天。共切除和检查了 3569 个淋巴结（LN），其中 2879 个为阴性。120 例患者均检查了 15 个以上的淋巴结。中位数为 29 个（范围 17 至 64；均数 29.7±标准差 9.6），中位数阳性淋巴结数为 5 个（范围 0 至 37；均数 5.8±标准差 7.1）。术后并发症总发生率为 10.8%，住院死亡率为 0%。这些患者的中位随访期为 34.3 个月（范围 10 至 53 个月），总体 3 年生存率为 40.6%。