本文選題：胃腫瘤　切入點：脾門淋巴結　出處：《安徽醫(yī)科大學》2016年碩士論文　論文類型：學位論文

【摘要】：背景與目的胃癌是常見的消化道惡性腫瘤,手術是唯一可能治愈的方法。區(qū)域淋巴結清掃是D2根治術的基本組成部分,然而術前缺乏準確判斷區(qū)域淋巴結轉移或微轉移的方法。本研究通過對82例進展期中上部胃癌患者的脾門淋巴結轉移(包含微轉移)情況進行分析,了解其轉移規(guī)律,對指引進展期胃癌手術具有重要的臨床意義。材料與方法收集安徽醫(yī)科大學第三附屬醫(yī)院(合肥市第一人民醫(yī)院及合肥市濱湖醫(yī)院)2011年8月至2014年8月82例行全胃切除D2根治術的進展期中上部胃癌患者臨床病理資料。通過卡方檢驗分析性別、年齡、腫瘤橫向部位、腫瘤大小、Borrmann分型、分化程度、浸潤深度、No.4s轉移、TNM分期、淋巴管侵犯對脾門淋巴結轉移(包含轉移、微轉移)的影響。為排除各種因素之間的相互作用,再采用logistic多元回歸模型對相關因素進行分析,P0.05為差異有統(tǒng)計學意義。結果進展期中上部胃癌脾門淋巴結轉移率為21.95%(18/82),微轉移率32.80%(21/64),總體轉移率47.56%(39/82)。單因素分析顯示腫瘤大小、TNM分期、Borrmann分型、腫瘤橫向部位是脾門淋巴結轉移的相關因素;多因素分析證實了腫瘤橫向部位、TNM分期、Borrmann分型是其獨立危險因素。對脾門淋巴結微轉移而言,單因素分析及多因素分析均提示T分期、腫瘤橫向部位是高危因素。結論TNM分期、Borrmann分型、腫瘤橫向部位、T分期是脾門淋巴結轉移或微轉移的獨立危險因素,而No.4s、淋巴管侵犯、年齡、性別、腫瘤大小、分化程度與脾門淋巴結轉移不存在明顯的相關性,因而在臨床上需對大彎側、BorrmannⅢ-Ⅳ型、Ⅲ或Ⅳ期、T3或T4的中上部胃癌患者常規(guī)行脾門淋巴結清掃。
[Abstract]:Background & objective gastric cancer is a common malignant tumor of the digestive tract and surgery is the only possible cure. Regional lymph node dissection is a basic part of D2 radical resection. However, there is a lack of accurate method to judge regional lymph node metastasis or micrometastasis before operation. In this study, 82 patients with advanced upper gastric cancer were analyzed for lymph node metastasis (including micrometastasis) in the splenic hilum. The data and methods collected from the third affiliated Hospital of Anhui Medical University (Hefei first people's Hospital and Hefei Binhu Hospital) from August 2011 to August 2014 were 82 cases. Clinical and pathological data of patients with advanced gastric cancer after D2 radical gastrectomy. Sex was analyzed by chi-square test. Age, tumor transverse location, tumor size and Borrmann classification, degree of differentiation, depth of invasion No.4s metastasis, TNM stage, lymphatic invasion of splenic hilar lymph node metastasis (including metastasis, micrometastasis). The logistic multivariate regression model was used to analyze the related factors. Results the lymph node metastasis rate of upper gastric carcinoma was 21.95 / 82%, the micrometastasis rate was 32.80% 21 / 64%, and the overall metastasis rate was 47.56% 39 / 82%. Univariate analysis showed that the tumor had a tumor metastasis rate of 39 / 82%. Borrmann classification of TNM by stage, TNM staging and Borrmann classification were independent risk factors for lymph node metastasis in splenic hilum, and multivariate analysis showed that TNM staging and Borrmann classification were independent risk factors for lymph node metastasis in splenic hilum. Univariate analysis and multivariate analysis showed that T stage and transverse location of tumor were high risk factors. Conclusion TNM staging and Borrmann classification are independent risk factors for lymph node metastasis or micrometastasis of splenic hilum, while no. 4 s, lymphatic vessel invasion. There was no significant correlation between age, sex, tumor size, differentiation degree and lymph node metastasis in splenic hilum, so it was necessary to perform routine splenic hilar lymph node dissection in patients with Borrmann type 鈪，

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