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目的检测胃幽门下(第6组)及其亚组淋巴结转移情况,以探讨临床合理清扫第6组淋巴结的价值。方法回顾性分析2006年1月至2009年12月期间我院80例接受根治性手术且有完整第6组及其3个亚组淋巴结送检资料的胃癌患者的临床病理资料,以胃网膜右静脉为参照将第6组淋巴结分为第6a、6b和6c亚组,计算第6组及其亚组淋巴结转移率和转移度,并对其淋巴结转移情况与胃癌临床病理特征和其他组(第7、8a和9组)淋巴结转移情况的关系进行logistic回归分析。结果 80例胃癌患者中第6组淋巴结转移率为41.3%(33/80),转移度为26.0%(108/415)。第6a亚组淋巴结转移率为7.5%(6/80),明显低于第6b亚组(16.3%,13/80)和第6c亚组(36.3%,29/80),P<0.001;第6a、6b和6c亚组淋巴结转移度分别为25.0%(8/32)、17.6%(13/74)和28.2%(87/309),差异无统计学意义(P=0.292)。第6a亚组阳性淋巴结与T分期(P=0.042)和N分期(P=0.006)有关;第6b亚组阳性淋巴结与N分期(P=0.002)和TNM分期(P=0.013)有关;第6c亚组阳性淋巴结与肿瘤分化程度(P=0.008)、T分期(P=0.003)、N分期(P=0.000)和TNM分期(P=0.000)有关。logistic回归分析显示:第6组淋巴结转移情况与第8a组淋巴结转移(P=0.023)和N分期(P=0.002)均有关;第6a亚组淋巴结转移与第8a组淋巴结转移有关(P=0.018);第6b亚组淋巴结转移与N分期有关(P=0.005);第6c亚组淋巴结转移与第8a组淋巴结转移(P=0.016)和N分期(P=0.004)均有关。结论胃癌手术中要彻底清扫第6组淋巴结,尤其要重视第6a和6b亚组淋巴结的清扫。
Objective To detect the status of lymph node metastasis under the pylorus (group 6) and its subgroups in order to investigate the value of clinically appropriate group 6 lymph node dissection. Methods From January 2006 to December 2009, 80 cases of gastric cancer who underwent radical surgery and had complete group 6 and 3 subgroups of lymph node were retrospectively analyzed. The clinical data of gastric cancer Right venous as the reference group 6 lymph nodes were divided into 6a, 6b and 6c subgroups to calculate group 6 and its subgroups lymph node metastasis rate and degree of metastasis, and its lymph node metastasis and clinical and pathological features of gastric cancer and other groups ( 7th, 8th and 9th group) lymph node metastasis were analyzed by logistic regression. Results The rate of lymph node metastasis in group 6 was 41.3% (33/80) and the degree of metastasis was 26.0% (108/415) in 80 patients with gastric cancer. The rate of lymph node metastasis in group 6a was 7.5% (6/80), significantly lower than that in group 6b (16.3%, 13/80) and group 6c (36.3%, 29/80) The lymph node metastasis rates of subgroups 6a, 6b and 6c were 25.0% (8/32), 17.6% (13/74) and 28.2% (87/309) respectively, with no significant difference (P = 0.292). The positive lymph nodes in subgroup 6a were related to T stage (P = 0.042) and N stage (P = 0.006). The positive subgroup in subgroup 6b was related to N stage (P = 0.002) and TNM stage (P = 0.013) Subgroup positive lymph nodes were correlated with tumor differentiation (P = 0.008), T stage (P = 0.003), N stage (P = 0.000) and TNM stage (P = 0.000) Logistic regression analysis showed that lymph node metastasis in group 6 was related to lymph node metastasis in group 8a (P = 0.023) and stage N (P = 0.002). The lymph node metastasis in group 6a was associated with lymph node metastasis in group 8a (P = 0.018 ). The lymph node metastasis in stage 6b was related to N stage (P = 0.005). The stage 6c lymph node metastasis was related to stage 8a lymph node metastasis (P = 0.016) and stage N (P = 0.004). Conclusion The sixth group of lymph nodes should be thoroughly cleaned out during the operation of gastric cancer. In particular, attention should be paid to the dissection of the lymph nodes in subgroups 6a and 6b.