Isozaki H, Okajima K, Yamada S, Nakata E, Nishimura J, Ichinona T, Tanimura M, Takeda Y
Department of General and Gastroenterological Surgery, Osaka Medical College, Japan.
Surg Today. 1995;25(1):21-6. doi: 10.1007/BF00309380.
To clarify the indications for a proximal subtotal gastrectomy in the treatment of carcinoma in the upper third of the stomach based on lymph node metastases, 1055 patients in whom either a D2 or greater lymph node removal was performed were reviewed. In the patients in which the lesion was confined to the upper stomach and did not invade beyond the muscularis propria of the stomach wall, no metastases to either the lymph nodes above and below the pylorus or the lymph nodes along the greater curvature were observed. A lymphatic flow study revealed a minimal flow to these nodes from the upper stomach in patients without lymph node metastasis, but in cases with lymph node metastases the lymphatic flow changed. The indications for a proximal subtotal gastrectomy for a carcinoma of upper third of the stomach therefore must fulfill the following two conditions: (1) The deepest layer of cancerous invasion does not extend beyond the muscularis propria of the stomach wall, and (2) No macroscopic evidence of lymph node metastasis can be detected during surgery.
为了基于淋巴结转移情况明确近端胃次全切除术在治疗胃上三分之一癌中的适应证，我们回顾了1055例行D2或更广泛淋巴结清扫术的患者。在病变局限于胃上部且未侵犯超过胃壁固有肌层的患者中，未观察到幽门上下淋巴结或大弯侧淋巴结转移。一项淋巴引流研究显示，在无淋巴结转移的患者中，从胃上部到这些淋巴结的淋巴引流极少，但在有淋巴结转移的病例中，淋巴引流发生了变化。因此，胃上三分之一癌行近端胃次全切除术的适应证必须满足以下两个条件：（1）癌浸润最深层未超过胃壁固有肌层；（2）手术中未发现淋巴结转移的宏观证据。
