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目的：为试行提高胃癌根治术手术的疗效，阐明胃癌生物学特性与第１６组淋巴结转移的关系，从而提出合适的Ｄ４式根治术指征，探讨此术式的可行性和意义。方法：对我院自１９９５年９月至１９９８年１１月所行的５６例无远处转移的Ｄ４式根治术病例，就反映肿瘤生物学特性的各临床、病理参数进行分析，祈能对Ｄ４式根治术提出合适的手术指征。结果：在５６例Ｄ４式根治术中，发现有第１６组淋巴结转移者１０例，转移率为１７．９％；而于浸润型胃癌、肿瘤直径大于５ｃｍ、肿瘤侵及浆膜以及第２、３站淋巴结受累时，第１６组ＬＮ转移率明显增高（Ｐ＜０．０５）；在第１６组的各分区ＬＮ中又以１６Ａ２和Ｂ１区的转移率更高。全组无手术死亡率，手术并发症也未见明显增加。结论：进展期胃癌中有相当一部分发生第１６组ＬＮ转移，且与胃癌各生物学特性参数相关。在正确掌握手术适应证的基础上，Ｄ４式胃癌根治术是相对安全可行的，其对胃癌手术的彻底性和远期疗效的意义，有待进一步积累经验。
Objective: To try to improve the curative effect of radical gastrectomy for gastric cancer, clarify the relationship between biological characteristics of gastric cancer and lymph node metastasis in group 16, and then put forward the appropriate D4 radical mastectomy indication to explore the feasibility and significance of this surgical procedure. Methods: 56 cases of D4 radical surgery with no distant metastasis performed in our hospital from September 1995 to November 1998 were analyzed on clinical and pathological parameters reflecting the biological characteristics of the tumor. Radical surgery suggests appropriate surgical indications. RESULTS: In 56 cases of D4 radical operation, 10 cases of lymph node metastasis were found in 10 cases, the metastasis rate was 17.9%; in invasive gastric cancer, tumor diameter greater than 5cm, tumor invading serosa, and 2nd When the 3 nodes were involved, the LN metastasis rate was significantly higher in the 16th group (P<0.05). In the 16th group, the 16N2 and B1 regions had higher metastasis rates in the LN. There was no operative mortality in the whole group, and no significant increase in surgical complications was observed. CONCLUSIONS: A significant proportion of advanced gastric cancers undergo LN metastasis in group 16 and are associated with biological parameters of gastric cancer. On the basis of correct understanding of surgical indications, D4 radical gastrectomy is relatively safe and feasible. Its significance for the thoroughness and long-term curative effect of gastric cancer remains to be further accumulated.