早期胃癌缩小手术与扩大手术治疗结果的比较.docVIP

???? 早期胃癌缩小手术与扩大手术治疗结果的比较 ???? ????摘要　目的：探讨早期胃癌缩小手术的适应证。方法：对138例早期胃癌的淋巴结转移特点及缩小手术与扩大手术治疗结果进行研究。结果：粘膜内癌淋巴结转移率为5.1％，其中Ⅰ站为3.9％，Ⅱ站为1.3％；1cm以下癌灶无淋巴结转移，1.5cm以上凹陷型早期胃癌开始出现淋巴结转移。粘膜下层癌淋巴结转移率为18.3％，其中Ⅰ站淋巴结转移率为18.3％，Ⅱ站为3.3％，1cm大小的癌灶开始发现淋巴结转移。随访5年以上的109例中，33例施行缩小手术（D1或D1＋N⑦），76例行扩大手术（D2、D2＋a或D3），两组死于胃癌复发转移的分别为13％、9％；其中死于淋巴结残胃转移复发的分别为6.4％、4.4％；死于淋巴结转移者原病灶均在3cm以上的凹陷型病灶中。结论：早期胃癌根治性缩小手术适合于粘膜内癌无溃疡的较小病灶病例，大部分仍需行D2或D2以上扩大手术。　　关键词　早期胃癌缩小手术胃切除术 Reduced vs Extended Gastrectomy in the Treatment of Early Gastric Cancer Shan Jixian Chen Junqing Liang Hongwei et al Department of Oncology, First Clinical College, China Medical University, Shenyang Abstract 　 Objective: To evaluate the justification of reduced gastrectomy in early gastric cancer. Methods: Status of lymph node metastasis was scrutinized in 138 cases of early gastric cancer undergoing extensive or reduced gastrectomy was made. Results:The rate of regional lymph node metastasis was 5.1％ in cases with mucosal lesions (m type) including group I nodes in 3.9％ and 1.3％ in group Ⅱ nodes. There was no lymph node involvement in lesions less than 1cm in diameter. Patients with depressed lesions larger than 1.5cm in diameter were most likely to have lymph node metastasis. In SM type early cancers nodal involvement was seen in 18.3％ of cases including group I 15％ and group II 3.3％ . The lymph node involvement was seen in cancers with 1cm in diameter. One hundred and nine patients was followed up for more than 5 years, 33 cases of those treated with reduced gastrectomy (D1 or D1＋ N⑦ ) and 76 cases treated with extensive resection (D2,D2＋ a or D3). In these two groups,deaths were accounted for by cancer recurrence and metastasis in 13％ and 9％ respectively. All of the patients who died of lymph node metastasis have had depressed lesions larger than 3cm in diameter. Conclusion: It is suggested that reduced radical gastrectomy is indicated in mucosal cancers and minute lesions without ulceration. D2 or D3 extensive resection is advisable