进展期中上部胃癌脾门淋巴结转移与微转移的分析

发布时间：2018-03-23 03:26

  本文选题：胃肿瘤　切入点：脾门淋巴结　出处：《安徽医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：背景与目的胃癌是常见的消化道恶性肿瘤,手术是唯一可能治愈的方法。区域淋巴结清扫是D2根治术的基本组成部分,然而术前缺乏准确判断区域淋巴结转移或微转移的方法。本研究通过对82例进展期中上部胃癌患者的脾门淋巴结转移(包含微转移)情况进行分析,了解其转移规律,对指引进展期胃癌手术具有重要的临床意义。材料与方法收集安徽医科大学第三附属医院(合肥市第一人民医院及合肥市滨湖医院)2011年8月至2014年8月82例行全胃切除D2根治术的进展期中上部胃癌患者临床病理资料。通过卡方检验分析性别、年龄、肿瘤横向部位、肿瘤大小、Borrmann分型、分化程度、浸润深度、No.4s转移、TNM分期、淋巴管侵犯对脾门淋巴结转移(包含转移、微转移)的影响。为排除各种因素之间的相互作用,再采用logistic多元回归模型对相关因素进行分析,P0.05为差异有统计学意义。结果进展期中上部胃癌脾门淋巴结转移率为21.95%(18/82),微转移率32.80%(21/64),总体转移率47.56%(39/82)。单因素分析显示肿瘤大小、TNM分期、Borrmann分型、肿瘤横向部位是脾门淋巴结转移的相关因素;多因素分析证实了肿瘤横向部位、TNM分期、Borrmann分型是其独立危险因素。对脾门淋巴结微转移而言,单因素分析及多因素分析均提示T分期、肿瘤横向部位是高危因素。结论TNM分期、Borrmann分型、肿瘤横向部位、T分期是脾门淋巴结转移或微转移的独立危险因素,而No.4s、淋巴管侵犯、年龄、性别、肿瘤大小、分化程度与脾门淋巴结转移不存在明显的相关性,因而在临床上需对大弯侧、BorrmannⅢ-Ⅳ型、Ⅲ或Ⅳ期、T3或T4的中上部胃癌患者常规行脾门淋巴结清扫。
[Abstract]:Background & objective gastric cancer is a common malignant tumor of the digestive tract and surgery is the only possible cure. Regional lymph node dissection is a basic part of D2 radical resection. However, there is a lack of accurate method to judge regional lymph node metastasis or micrometastasis before operation. In this study, 82 patients with advanced upper gastric cancer were analyzed for lymph node metastasis (including micrometastasis) in the splenic hilum. The data and methods collected from the third affiliated Hospital of Anhui Medical University (Hefei first people's Hospital and Hefei Binhu Hospital) from August 2011 to August 2014 were 82 cases. Clinical and pathological data of patients with advanced gastric cancer after D2 radical gastrectomy. Sex was analyzed by chi-square test. Age, tumor transverse location, tumor size and Borrmann classification, degree of differentiation, depth of invasion No.4s metastasis, TNM stage, lymphatic invasion of splenic hilar lymph node metastasis (including metastasis, micrometastasis). The logistic multivariate regression model was used to analyze the related factors. Results the lymph node metastasis rate of upper gastric carcinoma was 21.95 / 82%, the micrometastasis rate was 32.80% 21 / 64%, and the overall metastasis rate was 47.56% 39 / 82%. Univariate analysis showed that the tumor had a tumor metastasis rate of 39 / 82%. Borrmann classification of TNM by stage, TNM staging and Borrmann classification were independent risk factors for lymph node metastasis in splenic hilum, and multivariate analysis showed that TNM staging and Borrmann classification were independent risk factors for lymph node metastasis in splenic hilum. Univariate analysis and multivariate analysis showed that T stage and transverse location of tumor were high risk factors. Conclusion TNM staging and Borrmann classification are independent risk factors for lymph node metastasis or micrometastasis of splenic hilum, while no. 4 s, lymphatic vessel invasion. There was no significant correlation between age, sex, tumor size, differentiation degree and lymph node metastasis in splenic hilum, so it was necessary to perform routine splenic hilar lymph node dissection in patients with Borrmann type 鈪，

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