Okamura T, Tsujitani S, Korenaga D, Haraguchi M, Baba H, Hiramoto Y, Sugimachi K
Department of Surgery II, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
Am J Surg. 1988 Mar;155(3):476-80. doi: 10.1016/s0002-9610(88)80116-8.
The anatomic distribution, size, and histologic mode of involvement of 98 metastatic lymph nodes in 49 of 370 patients were examined to determine to what extent lymphadenectomy should be performed in addition to gastrectomy in patients with early gastric cancer. Nodal involvement in the marginal sinus (30 nodes) and partial medullary sinus (37 nodes) were commonly seen, and the lymph nodes of those types were enlarged compared with 1,086 patients with no metastatic lymph nodes (control group). Lymph nodes of the wide medullary sinus (11 nodes), small nodule (3 nodes), and massive involvement types (17 nodes) did not enlarge compared with those of the other types and those of the control group. Most of the metastatic sites (76.6 percent) were in the perigastric lymph nodes along the lesser and greater curvatures, about a fifth were in the extraperigastric nodes along the left gastric, common hepatic, celiac, and splenic arteries, and the least were in the extraperigastric nodes (3.1 percent) along the hepatoduodenal ligament. Since the rate of macroscopic diagnosis during operation was so poor, regardless of the histologic modes of nodal involvement, and also in cases of metastatic lymph nodes less than 15 mm in widest diameter, for curative operation of patients with early gastric cancer, perigastric and extraperigastric lymph nodes along the main arteries near the stomach should be completely dissected, in addition to resection of the stomach.
对370例患者中49例的98个转移性淋巴结的解剖分布、大小及组织学受累方式进行了检查，以确定早期胃癌患者在胃切除术后应进行多大范围的淋巴结清扫。边缘窦（30个淋巴结）和部分髓窦（37个淋巴结）受累较为常见，与1086例无转移性淋巴结的患者（对照组）相比，这些类型的淋巴结肿大。宽髓窦型（11个淋巴结）、小结节型（3个淋巴结）和大片受累型（17个淋巴结）的淋巴结与其他类型及对照组相比未肿大。大多数转移部位（76.6%）位于沿小弯和大弯的胃周淋巴结，约五分之一位于沿胃左动脉、肝总动脉、腹腔动脉和脾动脉的胃外淋巴结，最少的位于沿肝十二指肠韧带的胃外淋巴结（3.1%）。由于手术中的宏观诊断率很低，无论淋巴结受累的组织学方式如何，以及直径小于15mm的转移性淋巴结的情况，对于早期胃癌患者的根治性手术，除切除胃外，还应彻底清扫胃周和胃外沿胃附近主要动脉的淋巴结。
