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目的探讨胃癌前哨淋巴结转移途径,为外科医师合理清扫胃癌淋巴结提供理论依据。方法从中国医科大学附属第一医院收治的2786例胃癌患者当中,筛取231例发生单个或单站淋巴结转移病例,并分析其转移淋巴结的分布位置与组织学分级及组织学生长方式之间的关系。结果 231例单个或单站淋巴结转移病例中,196例(84.8%)转移到第一站淋巴结(N1),34例(14.7%)转移到第二站淋巴结(N2),1例(0.4%)转移到第三站淋巴结(N3)。84例单个淋巴结转移病例中,62例(73.8%)限于胃周淋巴结(N1)转移,21例(25.0%)转移至N2,1例(1.2%)转移至N3。147例单站淋巴结转移病例中,134例(91.2%)转移至N1,13例(8.8%)则转移至N2。结论胃癌前哨淋巴结转移规律中,以邻近转移为主,横向转移和跳跃转移也显著,且与肿瘤组织学分级、生长方式无关。因此,行胃癌根治手术时,至少行胃癌D2根治术。
Objective To investigate the pathogenic mechanism of sentinel lymph node metastasis in gastric cancer and provide a theoretical basis for surgeons to properly dissect the lymph nodes of gastric cancer. Methods A total of 2786 patients with gastric cancer admitted to the First Affiliated Hospital of China Medical University were enrolled in this study. 231 cases of single or single lymph node metastasis were screened. The distribution of lymph node metastasis and histological grade and histological length were analyzed relationship. Results Of the 231 cases with single or single lymph node metastasis, 196 cases (84.8%) were transferred to the first node (N1), 34 (14.7%) were transferred to the second node (N2), and 1 (0.4% Transfer to the third station lymph node (N3). Among the 84 cases with single lymph node metastasis, 62 cases (73.8%) were limited to the metastasis of gastric lymph nodes (N1), 21 cases (25.0%) to N2, and 1 case (1.2%) to N3.147 cases of single lymph node metastasis 134 cases (91.2%) were transferred to N1, 13 cases (8.8%) were transferred to N2. Conclusions Sentinel lymph node metastasis of gastric cancer is characterized by proximal metastasis, lateral metastasis and skip metastasis, and has no relation with tumor histological grade and growth pattern. Therefore, the line of gastric cancer radical surgery, at least line of gastric cancer D2 radical surgery.