Yamada S, Okajima K, Isozaki H, Nakata E, Nakajima T, Hara A
Department of Surgery, Osaka Medical College, Takatsuki, Japan.
Nihon Geka Gakkai Zasshi. 1989 Sep;90(9):1314-7.
In 77 cases with gastric cancer, for which lymph node dissection around the left renal vein was performed in the past 5 years, the sites and routes of metastasis were investigated to determine the indication for dissection around the left renal vein. The rate of metastasis to the lymph nodes around the left renal vein was 23.4%. The typical routes of metastasis were 1) the left lower phrenic route, 2) via the splenic artery, 3) via the celiac artery, 4) via the superior mesenteric artery and 5) the postpancreatic route. Dissection was considered to be indicated for the patient with N2 or more distant lymph node involvement and for cases with carcinoma of the upper part of the stomach or whole stomach with N2 positive lymph node. It was also indicated for N3(+) cases or No. 9(+) cases of carcinoma of the middle and lower parts of the stomach. Needless to say the absence of other non curative factors is required.
在过去5年中对77例胃癌患者进行了左肾静脉周围淋巴结清扫，研究转移部位和途径以确定左肾静脉周围清扫的指征。左肾静脉周围淋巴结转移率为23.4%。典型的转移途径为：1）左膈下途径；2）经脾动脉；3）经腹腔动脉；4）经肠系膜上动脉；5）胰后途径。对于N2或更远处淋巴结受累的患者以及胃上部或全胃癌伴N2阳性淋巴结的病例，认为应进行清扫。对于胃中下部癌的N3（+）病例或第9组（+）病例也适用。当然，还需要不存在其他非治愈性因素。
