中国实用外科杂志

中国实用外科杂志

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腹腔镜胃癌手术淋巴结不符合与预后相关性及其影响因素分析

林光锬，陈起跃，郑朝辉，李    平，谢建伟，王家镔，林建贤，陆    俊，黄昌明   

  1. 福建医科大学附属协和医院胃外科  福建医科大学消化道恶性肿瘤教育部重点实验室，福建福州 350004
  • 发布日期:2020-07-23

  • Published:2020-07-23

摘要： 目的    分析腹腔镜胃癌根治术中淋巴结不符合与胃癌病人预后的相关性及其影响因素。方法    回顾性分析2007年6月至2013年12月福建医科大学附属协和医院胃外科同一组医师收治的1745例行腹腔镜胃癌D2根治术病人的临床资料。分析淋巴结不符合对病人术后远期疗效的影响，并分析淋巴结不符合的术前高危因素。结果    所有病人的淋巴结不符合率为39.3%，其中根治性全胃切除和远端胃切除病人的淋巴结不符合率分别为52.1%和23.6%。淋巴结不符合与年龄、BMI、腹部手术史、肿瘤部位和胃切除类型具有相关性（P均<0.05）。淋巴结符合组病人5年存活率高于淋巴结不符合组（65.8% vs. 53.2%，P<0.001）。基于临床T分期进行分层，cT1期胃癌病人淋巴结符合组与不符合组的5年存活率差异无统计学意义（84.6% vs. 91.2%，P=0.369），而cT2~cT4期胃癌病人淋巴结符合组的5年存活率高于淋巴结不符合组（56.0% vs. 40.0%，P<0.05）。Cox回归分析显示，淋巴结不符合为胃癌病人远期预后不良的独立危险因素。Logistic回归模型分析显示，年龄≥65岁、BMI≥25、腹腔镜全胃切除为淋巴结不符合的独立危险因素。结论    淋巴结不符合是行腹腔镜胃癌根治术病人预后不良的独立危险因素；高龄、高BMI及腹腔镜根治性全胃切除术是术中出现淋巴结不符合的高危因素。

关键词: 胃癌, 腹腔镜胃癌根治术, 淋巴结不符合, 预后

Abstract: Lymph node noncompliance affects the long-term prognosis of patients with gastric cancer after laparoscopic radical gastrectomy and analysis of its high-risk factors        LIN Guang-tan，CHEN Qi-yue，ZHENG Chao-hui，et al. Department of Gastric Surgery，Fujian Medical University Union Hospital，Fuzhou 350004，China
Corresponding author：HUANG Chang-ming，E-mail：hcmlr2002@163.com
Abstract    Objective    To investigate the effect of lymph node noncompliance on the long-term prognosis of patients after laparoscopic radical gastrectomy and explore the risk factors of lymph node noncompliance. Methods    The clinicopathological data of gastric cancer patients who underwent laparoscopic radical gastrectomy with D2 lymph node dissection from June 2007 to December 2013 in the same surgeon team in Department of Gastric Surgery，Fujian Medical University Union Hospital were analyzed retrospectively. The incidence of lymph node noncompliance and its effect on the long-term prognosis of patients after laparoscopic radical gastrectomy were analyzed and the risk factors of lymph node noncompliance was explored. Results    The overall lymph node noncompliance rate was 39.3%，among which，the rate of lymph node noncompliance in laparoscopic total gastrectomy and laparoscopic distal gastrectomy were 52.1% and 23.6%，respectively. Lymph node noncompliance was significantly correlated with age，body mass index，the history of previous abdominal surgery，tumor location，and type of gastrectomy (all P<0.05). In the whole group，the overall five-year survival rate in those patients with lymph node compliance was significantly higher than those who were noncompliant (65.8% vs. 53.2%，P<0.001). Based on the stratified analysis of preoperative cT staging，there was no difference in the overall five-year survival rate of patients with and without lymph node noncompliance in cT1 stage patients (84.6% vs. 91.2%，P=0.369)，while the overall survival rate of patients with lymph node compliance in cT2-4 stage was significantly higher than that of patients with lymph node noncompliance (56.0% vs. 40.0%，all P<0.05). Cox regression model results showed that lymph node noncompliance was independent risk factor for long-term survival of patients with gastric cancer. Logistic regression analysis showed that age≥65 years，BMI≥25 and laparoscopic total gastrectomy were independent risk factors for predicting lymph node noncompliance. Conclusion    Lymph node noncompliance is an independent risk factor for poor prognosis in patients after laparoscopic radical gastrectomy. Age≥65 years，BMI≥25 and laparoscopic total gastrectomy are independent risk factors for predicting lymph node noncompliance.

Key words: gastric cancer, laparoscopic radical gastrectomy, lymph node noncompliance, prognosis