Regueira F M, Hernández-Lizoain J L, Torramadé J, Díez-Caballero A, Sierra A, Pardo F, Cienfuegos J A
Dpto. de Cirugía General, Clínica Universitaria de Navarra, Pamplona.
Rev Esp Enferm Dig. 1994 Dec;86(6):884-90.
The extended lymphadenectomy has been proposed as routine procedure in the surgical treatment of gastric cancer, although some controversies have been published. We present a retrospective analysis on the impact of extended lymph node dissection after total gastrectomy, in terms of post-operative course and histopathologic findings, in a group of 30 patients with R2 lymphadenectomy and in 16 patients with R1 lymphadenectomy. There were no significant differences in duration of operation, amount of blood transfusion and length of hospital stay between the 2 groups. The only significant difference was found in the greater amount of drainage output after R2 lymphadenectomy as compared with R1. There were no mortalities in either group and morbidity rate was similar for both [43% in R1 and 40% in R2) mostly in the form of abdominal infections (18% in R1 and 16% in R2]). A significantly greater number of lymph nodes was identified after R2 gastrectomy. Fifty-three per cent of patients has positive lymph nodes, 12% of them being from the N2 echelon of nodes (including one case of early gastric cancer). Careful lymph node dissection in gastric cancer surgery allows a more precise staging of the tumor with no increase in postoperative morbidity.
尽管已有一些争议性报道，但扩大淋巴结清扫术仍被提议作为胃癌外科治疗的常规手术。我们对30例行R2淋巴结清扫术和16例行R1淋巴结清扫术的患者进行了回顾性分析，探讨全胃切除术后扩大淋巴结清扫对术后病程和组织病理学结果的影响。两组患者在手术时间、输血量和住院时间方面无显著差异。唯一显著的差异是，与R1组相比，R2组术后引流量更多。两组均无死亡病例，发病率相似（R1组为43%，R2组为40%），主要为腹部感染（R1组为18%，R2组为16%）。R2胃切除术后发现的淋巴结数量明显更多。53%的患者有阳性淋巴结，其中12%来自N2级淋巴结（包括1例早期胃癌）。在胃癌手术中仔细进行淋巴结清扫可使肿瘤分期更精确，且不增加术后发病率。
