作者：白飞1，李莎1，邓顺1，罗建红1，欧阳永忠1，谢江波1，李俊军1，贺卓1，黄波1，肖科1，尹彬1，王进峰1，徐彪铭1，肖亚洲2，林劲冠1，石朝晖2，谢海龙1，左朝晖1

单位：1. 中南大学湘雅医学院附属肿瘤医院/湖南省肿瘤医院 胃十二指肠胰腺胆道外科，湖南省肿瘤医院（湖南省肿瘤防治研究所） 肝癌转化医学联合研究中心和消化道肿瘤实验室，湖南 长沙 410013； 2.中南大学湘雅医学院附属肿瘤医院/湖南省肿瘤医院 肿瘤防治研究办公室，湖南 长沙 410013

Authors:  Bai Fei1, Li Sha1, Deng Shun1, Luo Jianhong1, Ouyang Yongzhong1, Xie Jiangbo1, Li Junjun1, He Zhuo1, Huang Bo1, Xiao Ke1, Yin Bin1, Wang Jinfeng1, Xu Biaoming1, Xiao Yazhou2, Lin Jinguan1, Shi Chaohui2, Xie Hailong1, Zuo Chaohui1

Unit:  1.Department of Gastroduodenal and Pancreatic Surgery, Translational Medicine Research Center of Liver Cancer, Laboratory of Digestive Oncology, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/ Hunan Cancer Hospital, Changsha 410013, Hunan, China； 2.Cancer Prevention and Cure Research Office, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/ Hunan Cancer Hospital, Changsha 410013, Hunan, China

摘要：

目的 探讨胃癌淋巴结转移的规律及在外科临床中的意义。方法 回顾性分析湖南省肿瘤医院2011年1月至2020年12月收治的4238例根治性胃癌的临床资料,对淋巴结转移的特点与TNM分期、癌灶的大小、癌灶的部位、手术方式和Borrmann分型的关系进行了分析。结果 4238例胃癌患者中,3012例出现淋巴结转移,转移率为71.07%(3012/4238),收集淋巴结为10 7334枚,平均每例为25.33枚;TNM分期中ⅢC期和Ⅳ期淋巴结转移率均为100%,癌灶直径大于7 cm的胃周淋巴结转移率最高,上部癌(U)中淋巴结转移率较高依次是No.1(34.21%),No.3 (29.87%),No.2 (23.42%)和No.7 (20.36%);中部癌(M)中淋巴结转移率较高依次是No.3(33.75%),No.4(26.17%),其中No.4d为19.59%,No.4Sb为21.58%,No.4Sa为9.56%;No.7(21.63%)和No.1(18.13%);下部癌(L)中淋巴结转移率较高依次是No.6(34.27%),No.3(32.23%),No.4(26.36%),其中No.4 d为30.54%,No.4Sb为24.58%,No.4Sa为0.86%和No.7(22.25%),在901例(21.26%)早期癌中188例出现淋巴结转移(20.09%)。D3式淋巴结清扫的淋巴结转移率高于D1式和D2式淋巴结清扫,Borrmann分型中Ⅳ型淋巴结转移发生率最高。结论 胃癌高发于中老年男性,农村高于城市,早期胃癌患者比例低。肿瘤部位和淋巴结清扫数为胃癌术后患者预后的危险因素。胃癌淋巴结的转移规律与胃癌灶的部位和恶性程度有关,进展期胃癌的根治术至少应行D2以上的淋巴结清扫术(包括D3手术)才能达到根治的目的。

关键词：胃癌; 淋巴结转移; 淋巴结清扫; TNM分期

Abstract：

Objective To evaluate the status of lymph node metastasis in gastric cancer and its clinical significance. Methods the clinical data of 4238 cases of radical gastric cancer treated in Hunan cancer hospital from January 2011 to December 2020 were retrospectively analyzed. The relationship between the characteristics of lymph node metastasis and TNM staging, the size of the tumor, the location of the tumor,surgical methods and Borrmann classification was analyzed. Results Lymph node metastasis were observed in 3012 of 4238 cases (71.07%). 10 7334 lymph nodes were found, and 25.33 lymph node metastasis per patient. Lymph node metastasis of TNM staging was 100% in stage IIIC and stage IV. Lymph node metastasis rates was higher in tumor﹥7 cm, Lymph node metastasis frequency was found in groups No.1(34.21%), No.3(29.87%), No.2(23.42%), and No.7(20.36%) at upper third stomach cancer; in groups No.3(33.75%), No.4(26.17%), and No.4d( 19.59%), No.4Sb (21.58%), No.4Sa (9.56%), No.7 (21.63%), and No.1(18.13%)at middle third stomach cancer; in groups No.6(34.27%), No.3(32.23%), No.4(26.36%), andNo.4d(30.54%), No.4Sb(24.58%), No.4Sa(0.86%), and No.7(22.25%)at lower third stomach cancer. 901 patients (21.26%) with early gastric cancer lymph node metastasis were observed in 188 of 901 cases (20.09%). Lymph node metastasis rate of D3 was higher than that of D1 and D2, and Borrmann type IV was higher than other Borrmann types. Conclusions The incidence of gastric cancer was higher in middle-aged and old men, in rural areas than in cities, and the proportion of patients with early gastric cancer was low. The proportion of patients with early gastric cancer is low. Distribution of metastatic lymph node is clearly related to the location of the tumor and gastric malignancy. The results of our study provide evidence for the need to perform a gastrectomy with at least D2 lymphadenectomy (include D3 lymphadenectomy) in advanced gastric cancer.

Key Words:  Gastric cancer; Lymphatic metastasis; Lymphadenectomy