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目的 探讨胃癌D4根治术的临床意义。方法 总结 1997年 10月至 2 0 0 3年 10月 5 2例胃癌D4根治术的经验 ,通过无瘤接触、杀瘤技术、手术技巧、淋巴结的阳性率、TNM分期及治疗预后等资料进行分析。结果 胃大部分切除术 4 8例 ,全胃切除 4例 ,全部治愈出院。共清除淋巴结 883个 ,其中淋巴结转移71 2 % ;37例有淋巴结转移及有 1例No .16转移。Ⅰb期占 2 8 9% ,Ⅱ期占 15 4 % ,Ⅲa期占 19 2 % ,Ⅲb期占 11 5 % ,Ⅳ期占 2 8 9%。其 1、2、3年的生存率分别为 84 6 %、71 2 %及 5 5 7%。结论 D4术式是一种安全、可行及有效的术式 ,可提高Ⅰ、Ⅱ、Ⅲa期的生存率 ,其不但能精确TNM分期 ,而且便于学术交流
Objective To investigate the clinical significance of radical resection of gastric cancer D4. Methods From October 1997 to October 2003, 52 cases of radical resection of gastric cancer treated with D4 radical radiotherapy were analyzed. The data were analyzed by tumor-free contact, tumor killing technique, operative technique, lymph node positive rate, TNM stage and prognosis . Results Most of the gastric resection in 48 cases, total gastrectomy in 4 cases, all cured and discharged. A total of 883 lymph nodes were removed, of which 71 2% were lymph node metastases; 37 had lymph node metastases and 1 had No.16 metastases. Ⅰ b period accounted for 289%, Ⅱ period accounted for 15 4%, Ⅲ a period accounted for 19 2%, Ⅲ b period accounted for 11 5%, Ⅳ period accounted for 2 8 9%. The 1-, 2-, and 3-year survival rates were 84.6%, 71.2% and 57.5% respectively. Conclusion D4 is a safe, feasible and effective surgical procedure, which can improve the survival rate of stage Ⅰ, Ⅱ and Ⅲa. It not only can accurately TNM staging, but also can facilitate academic exchange