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目的 探讨胃癌根治术保留胰脾功能清除脾门和脾动脉干淋巴结 (即No10、No11)的合理性和可行性。 方法 分析 439例手术切除的胃贲门、体部和全胃癌侵入胰脾情况 ;对 5 4例胃癌患者在术中从贲门和体部浆膜下注入亚甲兰观察胃的淋巴流向 ;6 3例胃癌采用保留胰脾功能性清除No10、No11淋巴结方法 ,与同期保胰法和胰脾切除法比较 ,分析No10、No11淋巴结转移率 ,观察术后并发症发生率和生存率。 结果 439例胃贲门、体部和全胃癌侵入胰脾机会不多 ,分别为 5 7%(2 5 /4 39)和 2 3%(10 /4 39) ;5 4例胃的美兰淋巴引流不进入脾脏和胰腺内。保留胰脾法、保胰法和胰脾切除法 3组No10、11淋巴结转移率分别为 17 5 %(11/6 3) ,19 1%(12 /6 3) ;2 0 8%(4 5 /2 16 ) ,2 5 %(5 4/2 16 ) ;2 0 %(6 /30 ) ,2 3%(7/30 ) ,差异无显著意义。 6 3例保留胰脾法术后并发症发生率和病死率均较保留胰法和胰脾联合切除法低 ,而生存期较高 ,5、10年生存率分别为 5 7 5 %、5 2 %,5 7 4 %、47 4 %和37 3%、30 %。Ⅱ、Ⅲa期患者保留胰脾手术的 5、10年生存率明显改善。 结论 保胰脾法是一个安全、切实可行的保留脏器功能的胃癌手术 ,术后并发症低、生存率高。尤对Ⅱ、Ⅲa期患者应行保留胰脾手术。
Objective To investigate the rationality and feasibility of reserving the functions of pancreatic and spleen in radical gastrectomy of gastric cancer to remove the lymph nodes of spleen and splenic artery (ie, No10 and No11). Methods A total of 439 surgically resected gastric cardia, body and total gastric cancers were invaded into the pancreas and spleen; the gastric lymph flow was observed in 58 patients with gastric cancer who underwent intracameral injection of methylene blue from the cardia and body. Gastric cancer was treated with preserved pancreatic spleen function to remove No10 and No11 lymph nodes. Compared with simultaneous pancreatic and pancreatic splenectomy, No10 and No11 lymph node metastases were analyzed to observe the incidence of postoperative complications and survival. RESULTS: The chance of invading the pancreas and spleen from gastric cardia, body, and total gastric cancer was very low in 439 cases, which were 57% (2 5 / 4 39) and 2 3% (10 / 4 39) respectively; Does not enter the spleen and the pancreas. The lymph node metastasis rates of No10 and No11 in the three groups of pancreatic spleen preservation, pancreatic preservation and pancreatic splenectomy were 175% (11/63), 191% (12/63), and 20% (45%), respectively. / 2 16 ), 2 5% (5 4/2 16 ); 2 0 % (6 / 30 ), 2 3% (7/30), the difference was not significant. The incidence of complications and mortality of the retained pancreatic spleen were lower than those of the retained pancreatic method and the combined pancreatic spleen and spleen method. The survival period was higher, and the 5-year and 10-year survival rates were 5 75% and 5 2 respectively. %, 5 7 4 %, 47 4 % and 37 3%, 30%. The 5-year and 10-year survival rates of pancreatic spleen surgery in patients with stage II and stage IIIa were significantly improved. Conclusion The method of preservation of the spleen is a safe and feasible operation for gastric cancer that retains organ function. The postoperative complications are low and the survival rate is high. Especially for patients with stage II and stage IIIa, pancreatic spleen surgery should be preserved.