Morbidity after D2 and D3 gastrectomy for node-positive gastric carcinoma.
Morbidity after D2 and D3 gastrectomy for node-positive gastric carcinoma.
复制标题
淋巴结阳性胃癌 D2 和 D3 胃切除术后的发病率。
DOI：
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发表时间：
1997
影响因子：
5.2
通讯作者：
K. Sugimachi
中科院分区：
文献类型：
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作者：
Y. Adachi;K. Mimori;M. Mori;Yoshihiko Maehara;K. Sugimachi
背景
多项研究显示胃癌根治术后的发病率和死亡率各不相同。是否应进行扩大淋巴结清扫仍存在争议。
研究设计
分析1975年至1990年接受根治性胃切除术和扩大淋巴结清扫术（D2、D3）的214例淋巴结阳性胃癌患者的病历，并结合术后并发症的类型和原因进行分析。
结果
总体发病率为 36%，远端胃切除术 (19%) 和全胃切除术 (53%) 患者之间存在显着差异 (p < .01)。远端胃切除术后的发病率与失血量（593 g 与 438 g 相比；p < .05）和输血（43% 与 21% 相比；p < .05）相关，而全胃切除术后的发病率与脾切除术（64% 与 40% 相比；p < .05）和手术持续时间（227 分钟与 204 分钟相比；p < .05）密切相关。然而，D2 夹层组（33%）和 D3 夹层组（40%）之间的发病率没有差异。
结论
根治性胃切除术和扩大淋巴结清扫术的发病率可以接受，但全胃切除术和脾切除术与淋巴结阳性胃癌患者的高发病率相关。
BACKGROUND
Several studies show various rates of morbidity and mortality after radical operation for gastric carcinoma. Whether or not extended lymph node dissection should be done is still controversial.
STUDY DESIGN
The medical records of 214 patients with node-positive gastric carcinoma who underwent radical gastrectomy and extended lymph node dissection (D2, D3) from 1975 to 1990 were analyzed with reference to the type and cause of postoperative complications.
RESULTS
The overall morbidity rate was 36 percent and was significantly different between patients with distal gastrectomy (19 percent) and total gastrectomy (53 percent) (p < .01). Morbidity after distal gastrectomy correlated with blood loss (593 g compared with 438 g; p < .05) and transfusion (43 percent compared with 21 percent; p < .05), whereas morbidity after total gastrectomy was closely linked to splenectomy (64 percent compared with 40 percent; p < .05) and duration of the operation (227 minutes compared with 204 minutes; p < .05). The morbidity rate was not different, however, between D2 dissection (33 percent) and D3 dissection (40 percent) groups.
CONCLUSIONS
Radical gastrectomy and extended lymph node dissection can be performed with an acceptable morbidity, but total gastrectomy with splenectomy was associated with high morbidity in patients with node-positive gastric carcinoma.