| Objective: Nowadays, gastric cancer is still one of the commonmalignant carcinoma which greatly affect human health. The morbidity ofgastric cancer is lower than lung cancer, ranking the2ndplace in China,withthe top death rate among all the carcinoma. Recently although the amount ofcarcinoma levels down slightly, death rate remains high in urban cities.Because early gastric cancer hardly has specific clinical signs and symptoms,the low detection rate leads to having developed into intermediate andadvanced stage. As a result, gastric carcinoma postoperative survival time isstill unsatisfied. Among advanced gastric carcinoma prognosis evaluationfactors, whether the lymph node metastasis or not and metastasis degree havebeen acknowledged as important independent factors. And always systemiclymph node dissection becomes a key point during the surgical therapy, andpartly determines one patient's postoperative survival time. However, how todissect and dissection scope has become one of the foci during the operation.Now we introduce the term "sentinel lymph node", which is the first lymphnode accepting the regurgitate cancer cells from the original cancer. The newconcept has great significance in the rule of lymph node metastasis. Comparewith former surgical therapy, modern surgical therapy focuses safety as well ascure rate, guarantee the life quality on the basis of satisfying survival rate.During radical operation, the key point is reasonable scope of lymph nodedissection which provides a possibility to the rational and standard surgicaltherapy. The article primarily analyses the metastasis rule of differentdispersive lymph node in advanced surgical therapy and its instructivesignificance in surgical therapy. These can provide basis for regulate therational surgical therapy and improve clinical efficacy and5-year survival rate. Methods: Collect1046qualified advanced gastric cancer patients whowere admitted into general surgery department of NO.4Hospital affiliatedHebei Medical university from Jan.2007to Dec2010.We systemic dissect lymph node during operation and classify them into5parts, cerdia fundus of stomach, body of stomach,antrum of stomach andtotal stomach, according to different location. count statistics and analyse therule of Lymph node metastasis in adveanced gastric cancers of differentlocation. These data are statistically described and analysed by software SPSS13.0and P＜0.05indicates stastistical significance.Results: There are2162advanced gastric cancer patients admitted ingeneral surgery department of NO.4Hospital affilliatted Hebei MedicalUniversity from Jan.2007to Det.2010,1699operations involved.1046cases(48.41%) are well up to standard,799male aged from27to89(average58),267female ages from25to86(average55.5), the male to female ratio is2.91to1. In terms of location, there are69cardia cases,278fundus of stomachcases,234body of stomach cases,446antrum of stomach cases,19totalstomach cases.1The total Matastasis rate of advanced gastric cancerThere are629cases which have Lymph node metastasis confirmed bypostopeprative pathology in1046cases, and the total metastasis rate in60.13%.2Metastasis rate of different location.69cardia cases,39cases behave lymph bode confirmed by pathology,the metastasis rate is56.52%.278fundus of stomach cases,152cases behave lymph bode confirmedby pathology,the metastasis rate is54.68%.234body of stomach cases,138cases behave lymph bode confirmed bypathology, the metastasis rate is58.97%.446antrum of stomach cases,284cases behave lymph bode confirmedby pathology,the metastasis rate is63.67%. 19total stomach cases,11cases behave lymph bode confirmed bypathology,the metastasis rate is57.89%.3Metastasis rate of different groupsThe3rd group has the highest metastasis rate, higher than group7,group6, group1, group8, and group4, group2, group5, group9,group11, and group12, group13, group10, group14, group16, group15.the metastasis rate is26.96%,24.47%,18.26%,15.20%,14.63%,13.38%,12.05%,5.83%,3.25%,2.39%,0.96%,0.67%,0.67%,0.10%, Accordingto χ2test, χ2=1834.122, P=0.000, P＜0.05, statistically significant.4The total Matastasis degree of advanced gastric cancer13709lymph nodes were picked.3640lymph node confirm tumormetastasis by pathology, the total lymph node metastasis degree is26.55%.5Metastasis degree of different locationThere are3944lymph node in cardia and fundus of stomach,937lymphnode confirm tumor metastasis by pathology, the lymph node metastasis rate is23.76%.There are3287lymph node in body of stomach,869lymph nodeconfirm tumor metastasis by pathology, the lymph node metastasis rate is26.44%.There are6250lymph node in antrum of total stomach,1642lymphnode confirm tumor metastasis by pathology, the lymph node metastasis rate is26.27%.There are234lymph node in total stomach,193lymph node confirmtumor metastasis by pathology, the lymph node metastasis rate is82.48%.According to χ2test, χ2=634.122, P=0.000, P＜0.05, statisticallysignificant.6Metastasis degree of different groupsLymph node metastasis degree of different group in advanced gastriccarcinoma from high to low is group3, group5, group6, group2, group7,group1,group16,group10,group14,group11,group4,group8,group13,group15,group9, and group12. the metastasis degree is35.23%,33.23%,31.73%, 31.64%,26.89%,26.83%,26.09%,25.93%,23.91%,21.91%,20.98%,19.78%,17.05%,16.67%,15.99%and9.75%, respectively.According to χ2test, χ2=634.122, P=0.000, P＜0.05, statisticallysignificant.7Metastasis rate of all locationThe3rd group in cardia and fundus of stomach has the highest metastasisrate, higher than group2, group1, group7, group9, group11, group8, group5, group4, group6.The3rd group in body of stomach has the highest metastasis rate, higherthan group7, group1, group6, group8, group4, group2, group5, group9,group11, group12, group16.The6th group in antrum of total stomach has the highest metastasis rate,higher than group3, group7, group8, group1, group9, group12, group14,group2, group1, group13, group16, group15.The3rd and7th group in total stomach have the highest metastasis rate,higher than group8, group4, group6, group1, group13, group9, group5,group1.8Lymph node metastasis of gastric cancer reveals skip metastasisphenomenon which is the commonest seen in group16Conclusion: In this paper, we statistically analyze1046clinical casesand conclude as follows:1The mobility of advanced gastric cancer is higher in men than wome2Advanced gastric carcinoma has high lymph node metastasis rate.3Among all part of gastric carcinoma, group3lymph node has highmetastasis rate.4Lymph node metastasis rate of different part of gastric carcinoma has noobvious statistical significance.5Different part of gastric carcinoma has diverse lymph node metastasis rate,the law could direct reasonable dissection scope during surgical therapy.6Every group of lymph node in advanced gastric cancer has the possibilityto metastasis, but owns different metastasis rates. According to it, standard D2 lymph node dissection is confirmed in treating advanced gastric cancer duringsurgical therapy, especially the operation scope can't be reduced at random7Lymph node metastasis of gastric carcinoma reveal skip metastasisphenomenon which will affect the validity of D2rational therapy... |
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