目的　通过研究进展期胃近侧癌淋巴结转移情况及相关因素 ,阐述合理的手术治疗。方法　复习 1982～ 1998年行根治性全胃切除的胃近侧癌手术的 16 8例 ,分析淋巴结的转移及有关预后。结果　淋巴结转移率为74 4%。肿瘤的大小、Borrmann分型及病理分型和浸润深度均与淋巴结转移相关 (P <0 0 1)。肿瘤侵及肌层 ,浆膜及浆膜外淋巴结转移率分别为 35 7%、81%和 10 0 %。肿瘤侵及肌层No⑤、⑥淋巴结转移分别为 2 5 %和 10 7% ,并随着外侵程度的加重向下转移率也明显增高。肿瘤侵犯肌层无脾门淋巴结转移 ,侵犯浆膜层及浆膜外分别达5 3%和 15 8% ,而No 淋巴结转移率为 0。N3 淋巴结转移率低 ,在 3%以下 ,极少数为跳跃式转移。肿瘤浸润浆膜外行联合脏器切除中 ,整块切除组预后好于浸润融合组 (P <0 0 5 )。死因中腹膜转移占 74% ,血行转移占 2 2 % ,而局部复发只占 4%。本组有 3 6 %为胃多发癌 ,发生于胃窦部。结论　 (1)进展期及对术前不能确定的早期胃近侧癌行全胃切除、D2 或D2 + 清除应为标准术式。 (2 )当肿瘤侵出浆膜外伴脾门部淋巴结转移或脾脏转移应切除脾脏或行联合脏器切除的D2 或D2 + 清除。 (3)当肿瘤明显外侵时扩大根治手术范围并不提高生存率 Objective To elucidate reasonable surgical treatment by studying lymph node metastasis and related factors in advanced gastric cancer. Methods A total of 168 cases of proximal gastric cancer undergoing radical total gastrectomy from 1982 to 1998 were reviewed. Lymph node metastasis and related prognosis were analyzed. Results The lymph node metastasis rate was 744%. The tumor size, Borrmann type, pathological type, and depth of invasion were all associated with lymph node metastasis (P < 0.01). Tumor invasion to the muscular layer, serous and serous extranodal lymph node metastases were 35.7%, 81%, and 100%, respectively. Tumor invasion and No5 and 6 lymph node metastasis in the muscular layer were 25% and 10%, respectively, and the rate of downward metastasis increased with the degree of external invasion. There was no metastasis of lymph nodes in the muscular layer of the tumor, invasion of the serosa and serosal membranes was 5 3% and 15 8%, respectively, and no lymph node metastasis was 0. N3 lymph node metastasis rate is low, below 3%, and very few are skipping metastases. In tumor-infiltrated serosa external joint organ resection, the prognosis of the whole resection group was better than that of the infiltrating fusion group (P < 0.05). Among the causes of death, peritoneal metastasis accounted for 74%, and hematogenous metastasis accounted for 2%, while local recurrence only accounted for 4%. 36% of the patients in this group had multiple gastric cancers and occurred in the gastric antrum. Conclusions (1) Progressive and total gastrectomy, D2, or D2 + clearance of early proximal gastric cancer that cannot be determined before surgery should be standard surgical procedures. (2) D2 or D2 + removal of the spleen or combined organ resection should be performed when the tumor invades the serosa outside of the serous membrane with lymph node metastasis or splenic metastasis. (3) Expanding the scope of radical surgery does not improve survival when the tumor is significantly invaded