目的:通过研究进展期胃远侧癌淋巴结转移情况及相关因素,阐述胃远侧癌合理的手术方式.方法:复习1990～1995年行根治性远端胃次全切除或全切除的胃远侧癌手术17 1例,分析淋巴结的转移及有关预后情况.结果:淋巴结转移率为74 .9%.肿瘤大小、Barrm ann分型和浸润深度均与淋巴结转移相关.肿瘤侵及肌层、浆膜及浆膜外淋巴结转移率分别为35.4%、73.2%和100%.肿瘤侵及肌层即有No③～⑧淋巴结转移,随着外侵程度加重,向近侧转移率明显增高,No①转移率为14%.肿瘤侵及邻近脏器的,整块切除者好于脏器局部切除者.结论:(1)进展期胃远侧癌行远端胃次全切除加D2或D 2+淋巴结清除术应为标准术式.(2)胃角癌直径>5 cm或No①淋巴结癌转移者应行全胃切除加D2或D2+ 淋巴结清除术.(3)浸润邻近脏器的胃远侧癌应联合脏器整块切除加D2或D2+淋巴结清除术.

[1] KAZUYA K, SATOKI N, KAZUHITO Y. Lymph node metastasi s in gastric cancer in the upper third of stomach surgical treatment on the bas is of the anatomi cal distribution of positive node, 1998(19)
[2] JBGEN D R, KNUT B J, RBDIER S. 3.0.CO, 2-H.aspx">Prognostic factor in gastric c arcinoma. 1993(7). doi:10.1002/1097-0142(19931001)72:7&lt, 2089::AID-CNCR2820720706&gt, 3.0.CO, 2-H
[3] Yoshihiko M, MASAAKI T, SHINCHI T. Surgical treatment and outco me for node-negative gastric cancer. 1997(6). doi:10.1016/S0039-6060(97)90051-9
[4] HAYES N, NG E K, RAIMES S A. Total gastrectomy with extended ly mph adenectomy for curable stomach cancer:experience in a non-Japanese Asian c enter. 1999(1). doi:10.1016/S1072-7515(98)00274-9
[5] 王舒宝. 从胃癌手术的历史演变探讨胃癌的现代外科治疗, 1999(6)