| ObjectiveIn recent years,gastric cancer,in particular on the transfer of research of gastric cancer has been the focus of attention.Lymph node metastasis of gastric cancer metastasis is the major mode of the number of metastasis lymph nodes and part of it is affecting the most important factor in prognosis of gastric cancer,gastric cancer treatment is the most effective surgical excision,therefore lymph node dissection is the main contents of patients with gastric cancer.Wide excision without lymph node metastases,may affect the body's immune function,may increase the surgical trauma, not conducive to the improvement of surgical treatment.In order to achieve guided surgery and reduce the postoperative complications,and even further narrow the scope of surgical radical resection but also the purpose of sentinel lymph node(sentinel lymph node) concept was applied to gastric cancer surgery.Isolation of metastasis lymph nodes are malignant pathological examination after radical resection the only lymph node metastasis.To the characteristics of solitary lymph node metastasis of gastric cancer in line with the concept of SLN.The authors considered as sentinel lymph nodes,to study the anatomical location of gastric cancer and metastasis lymph nodes isolated location of their relationship and stomach anatomy parts,the main cancer,size,depth of invasion,growth pattern,histological type,pathological macroscopic type,lymphatic vessel invasion factors such as parts of lymph node metastasis of gastric cancer correlation,analysis of the characteristics of lymph node metastasis of gastric cancer to guide surgical dissection,and further understanding of complex multi-week lymphatic drainage to the stomach.And of analyze the distribution of metastasis lymph nodes in isolation in different positions,and the number of metastasis lymph nodes of different pairs of survival time of patients affected. Methods1.Research dataBy retrospective analysis from 1980 to 2006,the First Affiliated Hospital of China Medical University surgical oncology inpatients,preoperative endoscopy were performed and pathology proved to be the primary gastric cancer,gastric cancer after surgery and postoperative routine laboratory Pathological examination confirmed that only one metastasis lymph nodes of the patients had 236 cases.The selection of a clinical pathology and survival data integrity,non-T4,and M1,the non-palliative resection,line and above D2 radical resection of the patients had 150 cases.2.PacketJapanese Gastric Cancer Society to develop reference to the 14th edition of "Japan's handling of the Statute of gastric cancer" will be divided into 16 groups of lymph nodes of gastric weeks;originally made part of the anatomy of the stomach weeks of gastric cancer lymph node is divided into N1,N2,N3 stations.Gastric cancer specimens and pathological examination of lymph nodes from the First Affiliated Hospital of China Medical University Laboratory of gastric cancer using conventional HE staining,two pathologists diagnosis.The metastasis lymph nodes in the N1 is defined as the adjacent transfer(adjacent metastasis),the metastasis lymph nodes than in the N1 is defined as skip metastasis(skip metastasis).3.Analysis of the distribution of characteristics of lymph node metastasisTabulation analysis of lymph node metastasis and primary tumor location of the relationship between the anatomical location,analyzing different parts of the group of gastric cancer Yi Ho Ho points to the lymph node metastasis of gastric cancer in different parts of the rate of skip metastasis.4.Statistical analysisWill be close to the transfer of group and skip metastasis group sex,age,tumor site,size,depth of invasion,growth pattern,histological type,pathological macroscopic type,lymphatic vessel invasion factors such as case-control analysis,using X2 test (count data) and non-parametric test(measurement data when the data non-normal distribution);will be close to the transfer of group and skip metastasis group,no transfer,individual transfer,multiple metastasis of the postoperative survival time for case-control analysis,using Kaplan-Meier method log rank test.Using SPSS 13.0 statistical software,p less than 0.05 statistically difference.Results1.The overall distribution of metastasis of solitary lymph nodes methods and the phenomenon of skip metastasisIn 18 cases(12.00%),upper gastric cancer in 9 cases(50.00%),solitary metastasis lymph nodes are located in the neighboring tumor of the N1(No1,2),5 cases(27.77%) in the lesion relatively distant N1(No3,4);in 40 cases(26.67%),gastric cancer Central 22 cases(55.00%) solitary lymph node cancer appears in the neighborhood of the N1 (No3,4),9 cases(22.50%) are in the more distant points away from the tumor at the N1 (Nol,5,6);in 92 cases(61.33%) lower stomach cancer,36 cases(39.13%) metastasis lymph nodes appear in the near solitary of the tumor of the N1(No5,6),31 cases (36.70%) are located in the more distant from the tumor N1(No3,4).The upper part of the 18 cases of gastric cancer in 4 cases(22.22%),solitary metastasis lymph nodes in N2(No7,11),7 group accounted for 75.00%;40 cases of gastric cancer in the middle there are 7 cases(15.00%) solitary metastasis lymph nodes are located in N2(No7, 8,10),2 cases(5.00%) are located in N3(No2,10),7 group accounted for 55.55%;92 cases of gastric cancer in the lower part of a total of 25 cases(27.17%) occurred N2 skip metastasis(No1,7,8,9,11),7 group accounted for 32.00%.2.Various factors relatedComparison 38 cases(25.33%),skip metastasis and 112 cases(74.67%) close to the transfer of clinical and pathological features,surgical factors,by the X2 test p values are greater than 0.05,no statistical differences.The size of the primary cancer and lymph node detection of the number of non-normal distribution measurement data line non-parametric test,p values are greater than 0.05,no statistical differences.3.Survival ComparisonA single metastasis in patients with survival data are complete,the two groups in median survival time compared with the Log rank test,no significant difference(X2= 0.087,p=0.768).Similarly,the inclusion criteria over the same period and ward integrity and survival of 354 cases without metastasis,multiple metastases with a single transfer of 437 cases of the survival data of 150 cases compared to three groups median survival time was spent Log rank test,there is significant difference.(X2=71.131,p= 0.000)Conclusion1.Gastric carcinoma of the distribution of metastasis lymph nodes to isolate the overall performance of the distribution of the ground near and far way.The apparent phenomenon of skip metastasis.Prone to skip metastasis in gastric lesser curvature.2.Statistical analysis of primary gastric cancer by anatomic site,primary cancer size,depth of invasion,growth pattern,histological type,pathological type,lymphatic vessel invasion and whether there has been no significant correlation skip metastasis.3.Occurred close to the transfer of skip metastasis group and the group survival curves of D2 after removal was no significant difference.4.Gastric cancer with no lymph node metastasis,a single metastasis,multiple metastasis of the survival curve have a significant difference. |
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