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背景与目的:胃癌合适的切除范围问题一直是各国专家争论的焦点,本研究通过观察胃癌壁内浸润的距离,探讨手术切除胃壁的适宜长度。方法:选择中山大学肿瘤防治中心2002年4月至2004年2月间胃癌手术患者105例,术中测量其中18例牵拉前(L1)、牵拉后(L2)、离体后(L3)的胃组织长度改变,观察其的伸缩性。手术标本离体以后沿癌块中心,在肿瘤最大径上切取长条组织,按原形钉在木板上,分别测量上下切缘至肿瘤长度,制成大切片后镜下观察,并推算肿瘤离体后近端与远端实际浸润的长度。结果:18例胃组织的L2显著长于L1和L3(P<0.05),L1与L3则无统计学差异(P>0.05);早期胃癌、BorrmannⅠ型、BorrmannⅡ型等限局型胃癌胃壁内浸润长度均在2cm以内,BorrmannⅢ型、BorrmannⅣ型等浸润型胃癌癌缘外浸润长度均在5cm以内。结论:早期胃癌、BorrmannⅠ、Ⅱ型等限局型胃癌,其切除长度距肿瘤边缘2cm以上为宜;而浸润型胃癌,包括BorrmannⅢ型和BorrmannⅣ型胃癌,切除长度距肿瘤边缘5cm以上较为合适。
BACKGROUND & OBJECTIVE: The suitable resection scope of gastric cancer has been the focus of debate among experts all over the world. In this study, we investigated the appropriate length of resection of gastric wall by observing the infiltration distance of gastric wall. Methods: 105 patients with gastric cancer who underwent surgery from April 2002 to February 2004 at Sun Yat-sen University Cancer Center were enrolled in this study. Among them, 18 patients underwent preoperative extraction (L1), post-tensioning (L2), post-ex vivo (L3) The gastric tissue length changes, observe its scalability. Surgical specimens in vitro along the center of the cancer block, cut the maximum diameter of the tumor on long strips of tissue, nailing on the board according to the prototype, measuring the length of the upper and lower margin to the tumor length, making large slices and microscopically observed, After the proximal and distal length of the actual infiltration. Results: There was no significant difference in L1 between L2 and L3 (P> 0.05), while there was no significant difference between L1 and L3 in 18 gastric tissues (P> 0.05). The gastric infiltration length in gastric cancer with Borrmann type Ⅰ and Borrmann Ⅱ Within 2cm, Borrmann Ⅲ type, Borrmann Ⅳ type infiltration of gastric cancer infiltration margin length are within 5cm. Conclusion: For gastric cancer with Borrmann type Ⅰ and type Ⅱ, the resection length should be more than 2 cm from the edge of the tumor. However, the invasive gastric cancer, including Borrmann Ⅲ and Borrmann Ⅳ type gastric cancers, is more suitable for the resection of gastric cancer more than 5 cm in length.