Nakajima T, Ota K, Ishihara S, Oyama S, Nishi M
Division of Gastrointestinal Surgery, Cancer Institute Hospital.
Gan To Kagaku Ryoho. 1994 Aug;21(11):1751-7.
A total of 8,230 cases of gastric cancer treated at CIH were subjected to the analysis of the pattern of lymphatic spread with an aim of getting indication for the lymph node dissection of Small gastric cancer. Modified dissection (D1-alpha) is indicated for the patients with following conditions: 1) every elevated or flat type mucosal cancer, 2) excavated (IIc) type mucosal cancer less than 10mm in diameter, 3) elevated or flat type submucosal cancer less than 10mm in diameter, 4) excavated submucosal cancer less than 5mm in diameter. Extended dissection (D2 + alpha) is indicated for small cancer which exposed to serosa. Cancer in the upper thirds needs total gastrectomy or cardiectomy according to the state of #5 and 6 nodes, with complete dissection of #1 to 11 nodes associated with sampling of #16 nodes. Total gastrectomy with complete dissection of #1 to 11 nodes and sampling of #16 nodes is indicated for the advanced small cancer in the middle thirds, and total gastrectomy with complete dissection of #1 to 13 nodes and sampling of #14, 16 nodes is indicated for cancer in the lower thirds.
对在CIH接受治疗的8230例胃癌病例进行了淋巴转移模式分析，目的是为小胃癌的淋巴结清扫提供指征。改良清扫术（D1-α）适用于以下情况的患者：1）所有隆起型或平坦型黏膜癌；2）直径小于10mm的凹陷型（IIc型）黏膜癌；3）直径小于10mm的隆起型或平坦型黏膜下癌；4）直径小于5mm的凹陷型黏膜下癌。扩大清扫术（D2+α）适用于侵犯浆膜的小癌。上1/3段的癌根据第5和6组淋巴结情况行全胃切除术或贲门切除术，并完整清扫第1至11组淋巴结，同时对第16组淋巴结进行采样。中1/3段的进展期小癌行全胃切除术并完整清扫第1至11组淋巴结，同时对第16组淋巴结进行采样；下1/3段的癌行全胃切除术并完整清扫第1至13组淋巴结，同时对第14、16组淋巴结进行采样。
