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目的阐明淋巴结清扫与脾切除在残胃癌手术中的重要性。方法远端残胃癌患者63例,行D_2行淋巴结切除23例,非D_2淋巴结切除40例,并行脾切除30例,未行脾切除33例。观察患者的术后总体生存率,分析残胃癌患者全胃切除术后临床病理特征、手术治疗和长期预后。结果D_2淋巴结清扫术和非D_2淋巴结清扫术切除淋巴结的平均数量分别为(16.5±1.5)枚和(7.7±1.4)枚,两者比较差异有统计学意义(P<0.01);pT1/pT2肿瘤患者脾门区域无淋巴结转移,pT3/pT4肿瘤患者发生淋巴结转移4例;浸润深度为pT3/pT4肿瘤患者切脾组生存率高于保脾组(P<0.01),而pT1/pT2肿瘤患者差异无统计学意义(P>0.05);浸润深度为pT3/pT4肿瘤患者D_2淋巴清扫术组生存率高于非D_2组(P<0.01),而pT1/pT2肿瘤患者则无明显差异(P>0.05)。结论根治性淋巴结清扫与脾切除对晚期(pT3/pT4)残胃癌患者有益。
Objective To clarify the importance of lymph node dissection and splenectomy in residual gastric cancer surgery. Methods Sixty-three patients with distal residual gastric cancer were treated with D_2 lymph node dissection in 23 cases, non-D_2 lymph node excision in 40 cases, splenectomy in 30 cases, and no splenectomy in 33 cases. The overall postoperative survival rate was observed. The clinical and pathological features, surgical treatment and long-term prognosis of patients with gastric residual gastrectomy were analyzed. Results The mean number of resected lymph nodes between D 2 lymph node dissection and non-D 2 lymph node dissection was (16.5 ± 1.5) mm and (7.7 ± 1.4) mm, respectively, with statistical significance (P <0.01); pT1 / pT2 tumor There was no lymph node metastasis in the splenic region of the patient, and 4 cases of lymph node metastasis in pT3 / pT4 tumor. The survival rate of patients with pT3 / pT4 tumor was significantly higher than that in spleen-conserving group (P <0.01) (P> 0.05). The survival rate of patients with pT3 / pT4 tumor with D_2 lymph node dissection was significantly higher than that of non-D_2 group (P <0.01), but there was no significant difference between patients with pT1 / pT2 tumor (P> 0.05) ). Conclusions Radical lymph node dissection and splenectomy may benefit patients with advanced gastric (pT3 / pT4) residual gastric cancer.