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分析影响淋巴转移的高危因素，探讨剖腹缩小手术的适应证。方法对５２０例早期胃癌手术病理标本进行研究，比较粘膜内癌（ｍ癌）和粘膜下层癌（ｓｍ癌）大体分类、浸润深度、溃疡伴发和病灶大小以及病理类型与淋巴转移的关系，同时探讨剖腹缩小手术（保留大网膜的Ｄ１＋７廓清术）和Ｄ２廓清术的手术死亡率和并发症。结果在２７５例ｍ癌和２４５例ｓｍ癌中，Ⅱｃ型淋巴转移最多。小于２０ｍｍ的ｍ癌，均无淋巴转移；大于２０ｍｍ的１５３例（５５６％）中，淋巴转移有４例（Ｐ＜０．０１）。无溃疡病灶的１４６例中，仅１例（０７％）有淋巴转移；但伴有溃疡病灶的１２９例中，有３例（２３％）有淋巴转移（Ｐ＜０．０５）。Ｄ１＋７式（６６例）术后肠梗阻的发生率较Ｄ２式（２５９例）有明显下降（１５％比１５％；Ｐ＜０．０１）。而手术死亡率和长期生存率则无明显变化。结论本组结果提示ｓｍ癌较ｍ癌易发生淋巴转移，而ｓｍ癌伴有溃疡时更易发生Ｎ２淋巴转移。因此剖腹缩小手术（Ｄ１＋７廓清术）的适应证宜为２０ｍｍ以下未伴有溃疡的ｍ癌。确定缩小手术适应证的前提是术前高精度的浸润深度的确定和术中准确的病理形态学诊断
Analyze the high-risk factors that affect lymphatic metastasis and discuss the indications of laparotomy. Methods A total of 520 surgical specimens of early gastric cancer were studied to compare the relationship between gross classification, depth of invasion, ulceration and lesion size, pathological type and lymphatic metastasis of intramucosal cancer (m cancer) and submucosal cancer (sm cancer). To investigate the operative mortality and complications of laparotomy (D1+7 preservation of omentum) and D2 clearance. Results Among the 275 cases of m cancer and 245 cases of cancer, the type IIc lymph node metastasis was the most. There was no lymphatic metastasis in m cancers less than 20 mm, and in 4 of 153 (55.6%) patients larger than 20 mm (P < 0.01). In 146 patients without ulcer lesions, lymph node metastasis occurred in only 1 patient (0.7%), but in 129 patients with ulcer lesions, 3 (2% and 3%) had lymphatic metastasis (P<0.05). . The incidence of intestinal obstruction after D1+7 (66 cases) was significantly lower than that of D2 (259 cases) (15% vs. 15%; P<0.01). There was no significant change in operative mortality and long-term survival. Conclusions The results of this study suggest that sm cancer is more prone to lymphatic metastasis than m cancer, but it is more prone to N2 lymph node metastasis when sm cancer is associated with ulceration. Therefore, the indication for laparotomy (D1+7 clearance) should be less than 20 mm in diameter for m cancer without ulceration. The premise of confirming the surgical indication is to determine the depth of preoperative high-precision infiltration and accurate intraoperative pathological diagnosis