摘要目的 探讨进展期胃下部癌D2根治术第13组淋巴结清扫的必要性及可行性.方法 收集2001年1月至2007年6月问行胃下部癌D2/D2+根治术治疗、经病理确诊为腺癌且随访资料完整的胃癌患者共379例,依据第13组淋巴结清扫与否将患者分为清扫组与未清扫组.回顾性分析患者的临床病理资料,总结影响进展期胃下部癌预后的临床病理因素以及第13组淋巴结清扫的必要性和可行性.结果 379例患者中清扫组100例(26.4％),清扫组中淋巴结转移阳性患者9例(9.0％).清扫组与未清扫组患者性别、年龄、肿瘤最大径、分化程度、Borrmann分型、十二指肠浸润、浸润深度、淋巴结转移、TNM分期、手术时间、术中失血量、术后并发症的差异均无统计学意义(P＞0.05).Kaplan-Meier生存分析及Log-rank检验结果显示,清扫组的5年生存率(46.0％)明显高于未清扫组(36.5％,x2=4.452,P＜0.05).单因素分析显示,年龄(x2=7.539)、第13组淋巴结清扫与否(x2 =4.452)、肿瘤最大径(x2=7.100)、十二指肠浸润(x2=9.106)、浸润深度(x2=7.428)、淋巴结转移(x2=45.046)、TNM分期(x2=57.008)与进展期胃下部癌预后相关(P＜0.05)；多因素分析显示,年龄(HR =0.500,95％ CI:0.343 ～0.730)、肿瘤最大径(HR=0.545,95％ CI:0.339～0.876)、十二指肠浸润(HR =5.821,95％CI:2.326～14.572)、肿瘤浸润深度(T4:HR=2.087,95％ CI:1.283 ～3.394)是影响进展期胃下部癌预后的独立危险因素(P＜0.05).结论 对TNMⅡ～Ⅲ期进展期胃下部癌患者行D2+第13组淋巴结清扫是必要且安全可行的.

abstractsObjective To evaluate the feasibility and necessity of No.13 lymph node dissection in D2 radical gastrectomy for lower-third advanced gastric cancer (AGC).Methods Data of 379 cases who were diagnosed as TNM Ⅱ-Ⅲ stage AGC were collected from January 2001 to June 2007.One hundred cases who undergone No.13 lymph node dissection during D2 gastrectomy for lower-third AGC were selected as study group.Other 279 cases (control group) received only D2 gastrectomy.The differences in clinicopathologic and intraoperative and postoperative parameters and 5-years survival rate were compared using the SPSS 17.0 software.Results There were no significant differences between the two groups in patients' gender,age,tumor size,histologic type,Borrmann type,duodenum invasion,tumor depth,lymph node metastasis,TNM classification,operative time,blood loss and the incidence of postoperative complications (P ＞ 0.05).In the study group,there were 9 patients with positive No.13 lymph node,and its 5-year survival rate (46.0％) was higher than the control group (36.5％,x2 =4.452,P ＜0.05).The Univariate analysis showed that age (x2 =7.539),No.13 lymph node dissection (x2 =4.452),tumor size (x2 =7.100),duodenum invasion (x2 =9.106),tumor depth (x2 =7.428),lymph node metastasis (x2 =45.046),TNM classification (x2 =57.008) are associated with prognosis of lower-third AGC (P ＜ 0.05).Multivariate analysis identified age (HR =0.500,95 ％ CI:0.343-0.730),tumor size (HR =0.545,95％ CI:0.339-0.876),duodenum invasion (HR =5.821,95％ CI:2.326-14.572),and tumor depth (T4:HR =2.087,95％ CI:1.283-3.394) as independent prognostic factors (P ＜ 0.05).Conclusion No.13 lymph node dissection for TNM Ⅱ-Ⅲ stage lower-third advanced gastric cancer is feasible and necessary.