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目的检测胃癌患者肝十二指肠韧带淋巴结微转移,评估No.12淋巴结转移情况及其临床意义,为合理选择淋巴结清扫范围及评估预后提供依据。方法回顾性分析251例施行No.12淋巴结清扫的D2+胃癌根治手术患者的临床资料,连续切片并免疫组织化学方法检测210例常规病理检查No.12阴性淋巴结的微转移,分析No.12淋巴结转移与临床病理参数以及各亚组之间的关系,并进一步预后分析。结果淋巴结微转移的检出率为5.71%(12/210),No.12淋巴结转移率从常规病理检查的16.30%提高到21.11%。No.12淋巴结转移与浸润深度、肿瘤大小、临床分期、其它组淋巴结转移有显著相关性(P<0.01)。No.12a、12b淋巴结转移率分别为17.93%、11.16%,No.12a淋巴结转移与No.12b转移存在显著相关性(P<0.05)。临床分期与No.12淋巴结转移为独立预后因素。结论免疫组织化学方法检测细胞角蛋白敏感性高,可提高淋巴结转移的检出率。No.12淋巴结转移影响预后,进展期胃癌No.12组淋巴结清扫应作为常规,特别是No.12a与12b清扫,即肝十二指肠韧带的脉络化清扫。
Objective To detect micrometastases of hepatoduodenal ligaments in patients with gastric cancer and assess the metastasis status of No.12 lymph nodes and its clinical significance, so as to provide evidence for choosing the scope of lymph node dissection and assessing the prognosis. Methods The clinical data of 251 patients with radical resection of D2 + gastric cancer treated with No.12 lymph node dissection were retrospectively analyzed. The micrometastasis of 210 cases with routine pathological examination of No.12 negative lymph nodes was examined by serial sections and immunohistochemistry. The pathological changes of No.12 lymph node metastasis And clinicopathological parameters as well as the relationship between subgroups, and further prognostic analysis. Results The detection rate of lymph node micrometastasis was 5.71% (12/210). The rate of lymph node metastasis of No.12 increased from 16.30% to 21.11% of routine pathological examination. There was a significant correlation between lymph node metastasis and depth of invasion, tumor size, clinical stage and lymph node metastasis in other groups (P <0.01). The lymph node metastasis rates of No.12a and 12b were 17.93% and 11.16%, respectively. There was a significant correlation between No.12a lymph node metastasis and No.12b metastasis (P <0.05). Clinical stage and No.12 lymph node metastasis as independent prognostic factors. Conclusion Immunohistochemical detection of cytokeratin sensitivity, lymph node metastasis can increase the detection rate. No. 12 lymph node metastasis affects the prognosis of advanced gastric cancer No.12 lymph node dissection should be routine, especially No.12a and 12b dissection, that is, the hepaticoduodenal ligament of the venous cleaning.