作者：戴伟钢，蔡世荣

单位：中山大学附属第一医院 胃肠外科中心， 广东 广州 510080

Authors: Dai Weigang，Cai Shirong

Unit: Gastrointestinal Surgery Center，the First Hospital of Sun Yat-sen University，Guangzhou 510080，Guangdong，China

摘要：

胃癌是我国常见的消化道恶性肿瘤，其发病率呈逐年上升的趋势。然而，由于多数胃癌发现时处于进展期，因此其5年生存率仅为35.1%。规范化的淋巴结清扫是提高可根治胃癌患者总生存的重要手段。进展期远端胃癌No.12组淋巴结清扫的价值是争议的焦点问题之一。目前指南推荐对进展期远端胃癌实施包括No.12a在内的D2淋巴结清扫术，但将No.12b和No.12p列为第3站淋巴结。然而，No.12b、No.12p与No.12a特殊的解剖比邻关系和内在的淋巴管道沟通，似乎将No.12a、No.12b、No.12p作为特殊区域淋巴结进行彻底廓清更为合理。目前对于进展期远端胃癌进行彻底的No.12淋巴结清扫，能够提高患者总生存率。因此，本文结合最新的循证医学证据和本中心的临床经验，探讨进展期远端胃癌根治术中实施No.12淋巴结彻底廓清的临床价值。

关键词：进展期远端胃癌； No.12 淋巴结清扫； 循证医学

Abstract：

Gastric cancer is a common malignant tumor of the digestive tract ，and its incidence in China has shown an increasing trend in recent years. Nonetheless ，many patients are diagnosed with gastric cancer in an advanced stage，and the 5-year survival rate is only 35.1%. Standardized procedure in lymph node dissection is one of the important factors increasing the long-term survival of gastric cancer patients who received a standardized radical gastrectomy. The clinical value of No.12 lymph node dissection remains a controversial issue in gastrectomy for distal gastric cancer. D2 dissection of station No.12a lymph node is recommended in the current guidelines for the treatment of advanced gastric cancer, 12b and 12p lymph nodes are defined as N3 lymph nodes. However，it may be reasonable to dissect No. 12a，No. 12b，and No.12p as special regional lymph nodes because of their special anatomical proximity and internal lymphatic drainage. At present，No.12 lymphadenectomy can improve the overall survival of patients with locally advanced distal gastric cancer. Therefore，this study probed the clinical value of radical dissection of lymph node No.12 based on the latest evidence of evidence-based medicine and our clinical experience.

Key Words:  Distal gastric cancer； Dissection of lymph node No.12； Evidence-based medicine