發(fā)布時(shí)間：2018-09-14 16:02

【摘要】：目的:淋巴轉(zhuǎn)移是胃癌的主要轉(zhuǎn)移途徑,本實(shí)驗(yàn)通過分析驗(yàn)證影響幽門下區(qū)(6組)及其三個(gè)亞組淋巴結(jié)(6a,6i,6v)的轉(zhuǎn)移的臨床病理因素,探討6組淋巴結(jié)轉(zhuǎn)移情況下14v組淋巴結(jié)轉(zhuǎn)移的情況,以及清掃14v組淋巴結(jié)對(duì)患者預(yù)后的影響。方法:回顧性收集2013年1月至2015年12月間大連醫(yī)科大學(xué)附屬第一醫(yī)院胃腸外科治療的398例行胃癌根治術(shù)(D2或者D1+)的患者的臨床病理生理資料,篩選出清掃幽門下區(qū)(6組)患者,分析影響幽門下區(qū)(6組)及其三個(gè)亞組淋巴結(jié)(6a,6i,6v)的轉(zhuǎn)移的臨床病理因素,探討6組淋巴結(jié)轉(zhuǎn)移情況下14v組淋巴結(jié)轉(zhuǎn)移的情況,以及清掃14v組淋巴結(jié)對(duì)患者預(yù)后的影響。結(jié)果:1、398例患者中,清掃6組淋巴結(jié)轉(zhuǎn)移的患者有181例,約占總體的45.6%;6組淋巴結(jié)轉(zhuǎn)移的患者有53例。6a淋巴結(jié)轉(zhuǎn)移的患者有19例,轉(zhuǎn)移率為35.8%(19/53);6i組淋巴結(jié)轉(zhuǎn)移的患者有14例,轉(zhuǎn)移率為26.4%(14/53);6v淋巴結(jié)轉(zhuǎn)移的患者有20例,轉(zhuǎn)移率為22.6%(9/53);清掃第6a亞組淋巴結(jié)總共136枚,每例患者可得淋巴結(jié)(1.86±2.54)枚,其中陽性淋巴23枚,淋巴結(jié)轉(zhuǎn)移度為16.9%(23/136);清掃第6i亞組淋巴結(jié)總共86枚,每例得淋巴結(jié)(0.50±1.2)枚,轉(zhuǎn)移淋巴結(jié)16枚,淋巴結(jié)轉(zhuǎn)移度為18.6%(16/86);清掃第6v亞組淋巴結(jié)總共88枚,每例得淋巴結(jié)(0.93±1.07)枚,轉(zhuǎn)移淋巴結(jié)22枚,淋巴結(jié)轉(zhuǎn)移度為25.0%(22/88)。3個(gè)亞組淋巴結(jié)轉(zhuǎn)移度之間差異無統(tǒng)計(jì)學(xué)意義(P=0.342)。2、6組淋巴結(jié)轉(zhuǎn)移單因素分析顯示6組淋巴結(jié)轉(zhuǎn)移和腫瘤的大小,腫瘤的分化程度、N、M分期相關(guān)(p0.05);與與年齡、性別、腫瘤位置、腫瘤浸潤深度(T分期)無關(guān)(p0.05)。3、6a組和3組(p0.001)、4sb組(p0.001)、4d(p0.001)、5組(p0.001)、8a組(p0.001)9組(p0.001)、12組(p0.001)淋巴結(jié)有相關(guān)性,和14v組淋巴結(jié)沒有相關(guān)性(p=0.333);6i組和4sb組(p0.001)、4d(p0.001)、5組(p0.001)、7組(p0.001)、8a組(p0.001)、9組(p0.001)、12組(p0.001)淋巴結(jié)有相關(guān)性,和14v組淋巴結(jié)沒有相關(guān)性(p=0.068);6v組和3組(p0.001)、4sb組(p0.001)、4d(p0.001)、5組(p0.001)、7組(p0.001)、8a組(p0.001)、9組(p0.001)淋巴結(jié)、12組(p0.001)淋巴結(jié)有相關(guān)性,和14v組淋巴結(jié)有相關(guān)性(p0.001);4、將單因素分析中影響第6v組淋巴結(jié)轉(zhuǎn)移的腫瘤大小、分化程度度、N分期、M分期,及其第3、4sb、4d、5、6、7、8a、9、12a、14v組組淋巴結(jié)轉(zhuǎn)移納入logistic回歸進(jìn)行多變量分析,結(jié)果顯示:僅遠(yuǎn)處轉(zhuǎn)移,4d組、8a組、14v組淋巴結(jié)是6組淋巴結(jié)轉(zhuǎn)移的獨(dú)立危險(xiǎn)因素。TNM III期患者第14v組淋巴結(jié)轉(zhuǎn)移和未轉(zhuǎn)移患者3年生存率分別為42.9%和57.6%(p=0.005),TNM III期患者清掃14v組淋巴結(jié)可以明顯改善其預(yù)后。結(jié)論:1、有無遠(yuǎn)處轉(zhuǎn)移及第4sb、4d組8a組淋巴結(jié)轉(zhuǎn)移是影響第6v組淋巴結(jié)轉(zhuǎn)移的獨(dú)立危險(xiǎn)因素,第6組淋巴結(jié)轉(zhuǎn)移是預(yù)測第14v組淋巴結(jié)轉(zhuǎn)移情況的可靠指標(biāo)。2、I/11期患者第14v組淋巴結(jié)轉(zhuǎn)移率低,IV期患者預(yù)后差,第14v組淋巴結(jié)清掃并不能提高此類患者生存。3、Ill期胃中下部癌患者,如發(fā)現(xiàn)行6v淋巴結(jié)轉(zhuǎn)移,第14v組淋巴結(jié)轉(zhuǎn)移率相對(duì)較高,預(yù)防性清掃第14v組淋巴結(jié)可以改善預(yù)后。
[Abstract]:Objective: lymphatic metastasis is the main metastasis pathway of gastric cancer. The clinical and pathological factors influencing lymph node metastasis in subpyloric region (group 6) and its three subgroups (6aAX 6v) were analyzed in this study. To investigate the status of lymph node metastasis in 14v group under 6 groups of lymph node metastasis and the influence of dissection of 14 v group on the prognosis of the patients. Methods: the clinical pathophysiological data of 398 patients undergoing radical gastrectomy (D2 or D1) in the first affiliated Hospital of Dalian Medical University from January 2013 to December 2015 were retrospectively collected. The patients with subpyloric area (group 6) were screened out, and the clinicopathological factors affecting the metastasis of subpyloric region (group 6) and its three subgroups (6aAX 6v) were analyzed, and the status of lymph node metastasis in group 14v with subpyloric lymph node metastasis was discussed. And the effect of lymph node dissection on the prognosis of patients. Results among 1398 patients, 181 cases were dissected from 6 groups of lymph node metastases, and 53 cases (.6a) were involved in 53 cases of lymph node metastasis. The metastasis rate was 35.8% (19 / 53). There were 14 cases of lymph node metastasis. The metastatic rate was 26.4% (14 / 53) and the metastatic rate was 22.6% (9 / 53) in 20 patients with 6v lymph node metastasis, 136 lymph nodes were dissected in subgroup 6a, and (1.86 鹵2.54) lymph nodes were obtained in each patient, of which 23 were positive lymph nodes. The degree of lymph node metastasis was 16.9% (23 / 136), 86 lymph nodes were dissected in subgroup 6i, and the lymph nodes were (0.50 鹵1.2), 16 (18.6%) and (0.93 鹵1.07) lymph nodes were dissected in subgroup 6v, and the lymph node metastasis was 18.6% (16 / 86) in subgroup 6v, there were (0.93 鹵1.07) lymph nodes per case in subgroup 6i. There were 22 metastatic lymph nodes (25.0%) (22 / 88). There was no significant difference in lymph node metastasis among the three subgroups (P < 0.342) .2The univariate analysis of lymph node metastasis in 6 groups showed that the lymph node metastasis and tumor size in 6 groups. The degree of differentiation was correlated with age, sex, location of tumor, depth of invasion (T stage) (p0.05), and lymph nodes in group 3 (p0.001), 4d (p0.001), 8a (p0.001), 9 (p0.001) and 12 (p0.001) in group 3 (p0.001) and group 3 (p0.001) respectively, and there was no correlation between the degree of differentiation of the tumor and age, sex, tumor location, depth of tumor invasion (T stage), and 3 groups (p0.001), 4sb group (p0.001), 4d (p0.001), 8a group (p0.001), 9 group (p0.001) and 12 groups (p0.001). 鍜，

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