远端胃癌D3根治术的淋巴结清扫体会(2)
在我们的研究中，D3根治术组的5年生存率为44.4%，而D2根治术组的5年生存率为25.7%，前者明显高于后者，其差异具有统计学意义(P<0.05)。说明对于进展期胃癌行D3根治术确实能获得较 D2根治术更高的 5年生存率。Kunisaki[10]等报告对进展期胃癌进行D3根治术预后要好于D2根治术。万远廉等[11]报告进展期胃癌淋巴结转移率为77.4%，其中T2的患者淋巴结转移至N3、M1的8.1%；达T3、T4的患者转移至N3、M1的28.7%，认为对进展期胃癌应行D3根治术。Degiuli等[12]的报告亦认为D3根治术可提高进展期胃癌的术后生存率。表明D3根治术在适应证选择适当时，不失为一种有确切临床意义的术式。
我院在大量开展D2根治术的基础上开展D3术，D3根治术对于进展期远端胃癌病例，取得了一定的效果，提高了手术质量及根治度。笔者总的体会是: 在具备一定手术经验的基础上，D3胃癌根治术并不增加手术并发症, D3根治术能获取更多的淋巴结从而可能减少残留阳性淋巴结的危险，并能提高术后生存率。
, http://www.100md.com
参考文献
1 Lewis W. D2 or not D2 The gastrectomy question[J]. Gastric Cancer, 2002, 5(1): 29-34.
2 Sano T, Sasako M, Yamalnoto S,et al. Gastric cancer surgery: morbidity and mortality results from a prospective randomized controlled trial comparing D2 and extended para-aortic lymphadenectomy— Japan clinical oncology group study 9501[J]. J Clin Oncol, 2004, 22(14): 2767-2773.
3 詹文华, 何裕隆, 郑章清, 等. 进展期胃癌行腹主动脉旁淋巴结清扫的疗效观察[J]. 中华外科杂志, 2003, 41(5): 375.
, 百拇医药
4 Saito H. A Prospective pilot study of exteded(D3) and super extended para-aortic lymphadenestomy (D4) in patients with T3 or T4 gastric cancer managed by total pastrectomy[J]. J Sargery,1999,125(3): 352.
5 Schwarz RE, Smith DD. Clinical impact of lymphadenectomy extent in resectable gastric cancer of advanced stage[J]. Ann Surg Oncol, 2007, 14(2): 317-328.
6 MeCulloch P, Niita ME, Kazi H. et al. Gastrectomy with extended lymphadenectomy for primary treatment of gastric cancer[J]. Br J Surg, 2005, 92(1): 5-13.
, http://www.100md.com
7 Yoshikawa T, Sasako M，Sano T, et al. Stage migration caused by D2 dissection with para-aortic lymphadenectomy for gastric cancer from the results of a prospective randomized controlled trial[J]. Br J Surg, 2006 93(12): 1526-1529
8 Maeta M, Yamashiro H, Saito H, et al. A prospective pilot study of extended (D3) and superextendedpara-aortic lymphadenectomy (D4) in patients with T3 or T4 gastric cancer managed by total gastrectomy[J]. Surgery, 1999, 125(3): 325-331.
, 百拇医药
9 Tsujinaka T, Sasako M, Yamamoto S, et al. Influence of Overweight on Surgical Complications for Gastric Cancer: Results From a Randomized Control Trial Comparing D2 and Extended Para-aortic D3 Lymphadenectomy (JCOG9501) [J]. Ann Surg Oncol, 2007, 14(2): 355-361.
10 Kunisaki C, Akiyama H, Nomura M, et al. Comparison of surgical results of D2 versus D3 gastrectomy (para-aortic lymph node dissection) for advanced gastric carcinoma: a multi-institutional study[J]. Ann Surg Oncol, 2006, 13(5): 659-667
11 万远廉, 潘义生, 刘玉村, 等. 胃癌淋巴转移规律与淋巴结清扫范围的分析(附326例报告)[J]. 中华外科杂志, 2000, 38(10): 752-755.
12 Degiuli M, Sasako M, Calgara T,et al. D2 gastrectomy for gastric cancer，survival results of the IGCSG trial[M]. 4th ed. New York: Monduzzi, 2001, 25-27., http://www.100md.com(赵 峰 何圣敏 覃建魁 周自成 赵卫律 赵永雷 张君华)
我院在大量开展D2根治术的基础上开展D3术，D3根治术对于进展期远端胃癌病例，取得了一定的效果，提高了手术质量及根治度。笔者总的体会是: 在具备一定手术经验的基础上，D3胃癌根治术并不增加手术并发症, D3根治术能获取更多的淋巴结从而可能减少残留阳性淋巴结的危险，并能提高术后生存率。
, http://www.100md.com
参考文献
1 Lewis W. D2 or not D2 The gastrectomy question[J]. Gastric Cancer, 2002, 5(1): 29-34.
2 Sano T, Sasako M, Yamalnoto S,et al. Gastric cancer surgery: morbidity and mortality results from a prospective randomized controlled trial comparing D2 and extended para-aortic lymphadenectomy— Japan clinical oncology group study 9501[J]. J Clin Oncol, 2004, 22(14): 2767-2773.
3 詹文华, 何裕隆, 郑章清, 等. 进展期胃癌行腹主动脉旁淋巴结清扫的疗效观察[J]. 中华外科杂志, 2003, 41(5): 375.
, 百拇医药
4 Saito H. A Prospective pilot study of exteded(D3) and super extended para-aortic lymphadenestomy (D4) in patients with T3 or T4 gastric cancer managed by total pastrectomy[J]. J Sargery,1999,125(3): 352.
5 Schwarz RE, Smith DD. Clinical impact of lymphadenectomy extent in resectable gastric cancer of advanced stage[J]. Ann Surg Oncol, 2007, 14(2): 317-328.
6 MeCulloch P, Niita ME, Kazi H. et al. Gastrectomy with extended lymphadenectomy for primary treatment of gastric cancer[J]. Br J Surg, 2005, 92(1): 5-13.
, http://www.100md.com
7 Yoshikawa T, Sasako M，Sano T, et al. Stage migration caused by D2 dissection with para-aortic lymphadenectomy for gastric cancer from the results of a prospective randomized controlled trial[J]. Br J Surg, 2006 93(12): 1526-1529
8 Maeta M, Yamashiro H, Saito H, et al. A prospective pilot study of extended (D3) and superextendedpara-aortic lymphadenectomy (D4) in patients with T3 or T4 gastric cancer managed by total gastrectomy[J]. Surgery, 1999, 125(3): 325-331.
, 百拇医药
9 Tsujinaka T, Sasako M, Yamamoto S, et al. Influence of Overweight on Surgical Complications for Gastric Cancer: Results From a Randomized Control Trial Comparing D2 and Extended Para-aortic D3 Lymphadenectomy (JCOG9501) [J]. Ann Surg Oncol, 2007, 14(2): 355-361.
10 Kunisaki C, Akiyama H, Nomura M, et al. Comparison of surgical results of D2 versus D3 gastrectomy (para-aortic lymph node dissection) for advanced gastric carcinoma: a multi-institutional study[J]. Ann Surg Oncol, 2006, 13(5): 659-667
11 万远廉, 潘义生, 刘玉村, 等. 胃癌淋巴转移规律与淋巴结清扫范围的分析(附326例报告)[J]. 中华外科杂志, 2000, 38(10): 752-755.
12 Degiuli M, Sasako M, Calgara T,et al. D2 gastrectomy for gastric cancer，survival results of the IGCSG trial[M]. 4th ed. New York: Monduzzi, 2001, 25-27., http://www.100md.com(赵 峰 何圣敏 覃建魁 周自成 赵卫律 赵永雷 张君华)