胃癌浸润距离的研究与临床应用

doi:10.11904/j.issn.1002-3070.2016.04.006

摘要/Abstract

摘要：

目的探索在术中准确确定足够的胃壁切除范围,保证手术质量,提高患者生存率。方法以肿瘤边缘为中心向两侧逐渐取材(胃窦部肿瘤取上边缘,胃底贲门部肿瘤取下边缘,胃体部肿瘤取离体标本中较远一侧)、石蜡包埋、染色,判断肿瘤侵犯距离。结果黏膜层浸润距离≥5 cm的5例,3 cm≤黏膜层浸润距离＜5 cm的5例,0≤黏膜层浸润距离＜3 cm的118例,总计黏膜层浸润距离≥0 cm的128例,黏膜层浸润距离＜0 cm(即镜下所见浸润距离小于肉眼所见浸润距离)的218例。浆膜层浸润距离≥5 cm的6例,3 cm≤浆膜层浸润距离＜5 cm的19例,0≤浆膜层浸润距离＜3 cm的226例,总计浆膜层浸润距离≥0 cm的251例,浆膜层浸润距离＜0 cm的95例。经单因素分析结果表明:黏膜在镜下浸润距离是否大于肉眼所见距离与性别、年龄、最大直径、厚度、间质量和TNM分期相关。黏膜浸润距离与性别、垂直直径、肿瘤厚度、间质量和TNM分期相关。浆膜浸润距离与垂直直径、最大直径、肿瘤厚度、大体类型、组织学类型、间质量、浸润方式和TNM分期相关。结论 99%的患者肿瘤侵犯距离在5 cm以内,所以手术保证5 cm的手术切缘是必要的。肿瘤浸润距离与肿瘤的垂直直径、肿瘤厚度、间质量、浸润方式和TNM分期密切相关。

关键词: 胃癌, 浸润, 距离

Abstract:

Objective To explore the intraoperative process and determine that the stomach resection margin is accurate so as to ensure the quality of operation and improve the patients′ survival rate.Method Normally,tissue samples were continuously collected from two sides of visualized tumor edge as center.Specifically,the tissue samples were collected from upper side when tumor located at gastric antrum,collected from lower side when tumor located at gastric cardia,and collected from distant side when tumor located at gastric body.All samples were processed with paraffin embedding,staining,and were judged by the distance of tumor cell infiltration.Results The mucosa infiltration distance was more than 5 cm in 5 cases,more than 3 cm but less than 5 cm in 5 cases,and less than 3 cm in 118 cases.A total of 218 cases had less 0 cm mucosa infiltration distance,which was visualized distance less than the microscopic.The serosa infiltration distance was more than 5 cm in 6 cases,more than 3 cm but less than 5cm in 19 cases,and more or equal than 0 cm in 251 cases.A total of 95 cases had less 0 cm infiltration distance.The results of the single factor analysis showed that whether the general observed infiltration distance of the mucosal membrane was greater than what observed under the microscope,is associated with gender,age,maximum diameter,thickness of the tumor,external quality,and TNM stage.It significantly demonstrated the relationship of microscopic mucous membrane infiltration distance with sex,vertical diameter,thickness,stroma mass,and TNM stage.Stroma membrane infiltration distance significantly correlated with vertical diameter,the largest diameter,thickness,gross type,histological type,stroma mass,and TNM stage.Conclusion The infiltration of distance was less than 5 cm among ninety nine percent of patients with gastric cancer.Therefore,enlarged resection of 5 cm from visualized margin of tumor is necessary for operative treatment.There are associations between tumor infiltration distance and vertical diameter,thickness,stroma mass,manner of infiltration,and TNM stage.

Key words: Gastric carcinoma, Infiltration, Distance

中图分类号:

R735.2

庞锐,薛英威. 胃癌浸润距离的研究与临床应用[J]. 实用肿瘤学杂志, 2016, 30(4): 314-320.

PANG Rui,XUE Yingwei. The research and clinical application of gastric carcinoma with infiltration distance[J]. PRACTICAL ONCOLOGY JOURNAL, 2016, 30(4): 314-320.

参考文献

1 Shin D,Park SS.Making regarding proximal resection margin for gastric cancer[J].World J Gastrointest Oncol,2013,5(1):4-11.
2 Raziee HR,Cardoso R,Seevaratnam R,et al.Systematic review of the predictors of positive margins in gastric cancer surgery and the effect on survival[J].Gastric Cancer,2012,10(3):116-124.
3 Lee JH,Ahn SH,Parkdo J,et al.Clinical impact of tumor infiltration at the transected surgical margin during gastric cancer surgery[J].J Surg Oncol,2012,106(6):772-776.
4 Ding J,Liao GQ,Liu HL,et al.Meta-analysis of laparoscopy assisted distal gastmctomy with D2 lymph node dissection for gastric cancer[J].J Surg Oncol,2012,105(3):297-303.
5 陈宁,焦光辉.不同部位胃癌临床病理学特点及生物学行为对比分析[J].中国综合临床,2014,30(4):413-415.
6 李清国,王道荣,汤劲松,等.残胃癌与初发胃癌外科治疗及预后的比较研究[J].中华肿瘤防治杂志,2012,19(8):622-624.
7 Lee MS,Ahn SH,Lee JH,et al.What is the best reconstruction method after distal gastrectomy for gastric cancer?[J].Surg Endesc,2012,26(6):1539-1547.
8 陈宁,焦光辉.不同部位胃癌临床病理学特点及生物学行为对比分析[J].中国综合临床,2014,30(4):413-415.
9 Shin N,Jeon TY,Kim GH,et al.Unveiling lymph node metastasis in early gastric cancer[J].World J Gastroenterol,2014,20(18):5389-5395.
10 Gotoda T,Jung HY.Endoscopic resection(endoscopic mucosal resection/endoscopic submucosal dissection)for early gastric cancer[J].Dig Endosc,2013,25(1):55-63.
11 吴德南,庄建良,许荣誉,等.趋化因子受体CCR5在胃癌患者外周血调节性T细胞上的表达及其临床意义[J].中国肿瘤外科杂志,2014,6(3):137-140.
12 Choi J,Kim SG,Im JP,et al.Long-term clinical outcomes of endoscopic resection for early gastric cancer[J].Surg Endosc,2015,29(5):1223-1230.
13 Chiu PW.Novel endoscopic therapeutics for early gastric cancer[J].Clin Gastroenterol Hepatol,2014,12(1):120-125.
14 De Martel C,Forman D,Plummer M.Gastric cancer epidemiology and risk factors[J].Gastroenterol Clin North Am,2013,42(2):219-240.
15 Dawood S.Updates from Gastrointestinal ASCO 2015[J].Indian J Med Paediatr Oncol,2015,36(2):133-136.

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