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目的研究胃癌D3手术关键淋巴结清扫价值及对严重并发症进行分析。方法对84例胃癌UICC分期为Ⅱb期、Ⅲa期病人行标准胃癌D3根治术,对重要淋巴结转移率进行统计,对部分动脉行骨骼化处理,其鞘膜行病理学检查,对并发症进行统计分析。结果关键淋巴结转移率较高,是远期引起腹膜后淋巴结复发、胆管阻塞的病理基础,血管鞘有一定比例癌细胞浸润,D3手术可引起严重并发症,但可预防并解决。结论Ⅱb期、Ⅲa期病人行D3手术是有价值的,但需要在淋巴结清扫细节上有所注意,血管骨骼化有必要实施,部分并发症可以有效预防。
Objective To study the value of critical lymph node dissection in patients with gastric cancer D3 and to analyze the serious complications. Methods Eighty-four patients with gastric cancer UICC stage Ⅱb and Ⅲa were treated with standard radical gastrectomy for D3. The rates of important lymph node metastasis were calculated. Some arteries were subjected to skeletal pathological examination and the complications were statistically analyzed analysis. Results The high rate of lymph node metastasis was the pathological basis for long-term recurrence of retroperitoneal lymph nodes and obstruction of bile duct. The vascular sheath had a certain proportion of cancer cells infiltration. D3 surgery can cause serious complications, but can be prevented and solved. Conclusions D3 surgery is of value in stage Ⅱb and Ⅲa patients, but some attention should be paid to the details of lymph node dissection. Vascular skeletonization is necessary and some complications can be effectively prevented.