Chen J Q, Wang S B, Qi C L
Cancer Institute, China Medical University, Shenyang.
Zhonghua Yi Xue Za Zhi. 1995 Feb;75(2):110-3, 128.
To evaluate the effect and indication of different lymph node dissection (D1+, D2, D3), we performed radical operations for 371 cases of gastric cancer. The results showed that D1+ or D1 lymph node dissection was enough for gastric cancer of Ia stage, D2 was suitable for Ib stage. For localized or massive type gastric cancer of II + III stage, D3, D2 dissection was better than D1+ dissection. For the gastric cancer of the same type in IV stage, the 5-year survival rate after D3 + D2 dissection was 42.9%, but for the gastric cancer of infiltrative type or diffused growth pattern in II + III stage, the effect was not significantly increased even after the D3, D2 dissection. For the gastric cancer of this type in IV stage, the effect was not improved after the extended lymph node dissection. Extended dissection needn't be performed if there was no lymph node metastasis. D3, D2 dissection was better if there was little lymph node metastasis or the metastasis was limited to 1st group. For those metastasized to 2nd group or the quantity was more, D3 was better than D2, D1+. The effect of D3, D2 dissection was not significantly improved in the extensive metastasis case (more than 10 or to the 3rd group).
为评估不同淋巴结清扫术（D1 +、D2、D3）的效果及适应证，我们对371例胃癌患者实施了根治性手术。结果显示，对于Ia期胃癌，D1 +或D1淋巴结清扫已足够；D2适用于Ib期。对于II + III期局限性或肿块型胃癌，D3、D2清扫优于D1 +清扫。对于IV期同类型胃癌，D3 + D2清扫后的5年生存率为42.9%，但对于II + III期浸润型或弥漫生长型胃癌，即使行D3、D2清扫，效果也未显著提高。对于IV期该类型胃癌，扩大淋巴结清扫后效果并未改善。若无淋巴结转移，则无需进行扩大清扫。若淋巴结转移少或仅局限于第1组，D3、D2清扫更佳。对于转移至第2组或转移数量更多者，D3优于D2、D1 +。在广泛转移病例（超过10个或转移至第3组）中，D3、D2清扫效果未显著改善。
