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目的:探讨淋巴结阴性进展期胃腺癌患者手术后影响复发的相关因素及其复发模式。方法:随机选取2008年5月—2011年5月间行手术治疗的淋巴结阴性进展期胃腺癌患者238例,回顾性分析复发部位及病理因素。结果:随访2~5年,238例中52例发生复发,其中腹膜种植26例,局部复发26例,血行转移17例及淋巴结转移4例。影响腹膜种植相关因素为浆膜外侵、脉管浸润、Lauren分型肠型及硬癌间质反应,影响局部复发相关因素是浆膜外侵、肿瘤大小及微浸润生长分型;影响血行转移影响因素为脉管浸润。结论:淋巴结阴性进展期胃腺癌患者手术后复发模式主要为腹膜种植及局部复发,临床病理因素与复发模式相关,不同临床病理因素可导致不同复发模式。
Objective: To investigate the relapse-related factors and their recurrence patterns in patients with lymph node-negative advanced gastric adenocarcinoma after surgery. Methods: A total of 238 patients with lymph node-negative advanced gastric adenocarcinoma who underwent surgery between May 2008 and May 2011 were selected randomly. The recurrent sites and pathological factors were retrospectively analyzed. Results: Followed up for 2 to 5 years, 52 of 238 cases had recurrence, including 26 cases of peritoneal implantation, 26 cases of local recurrence, 17 cases of hematogenous metastasis and 4 cases of lymph node metastasis. The factors influencing peritoneal implantation were serosa invasion, vascular invasion, Lauren’s classification of interstitial and hard-cell interstitial reaction, and the factors affecting local recurrence were serosa invasion, tumor size and micro-infiltration growth type; The influencing factor is vascular infiltration. Conclusion: The main recurrence pattern of patients with advanced gastric adenocarcinoma with lymph node metastasis is peritoneal implantation and local recurrence. The clinical and pathological factors are related to the recurrence pattern. Different clinical and pathological factors may lead to different recurrence patterns.