摘要
Abstract
Objective To study the clinical value of radical resection of gastric carcinoma with pancr eas and spleen preservation (PSP) and functional cleaning of lymph nodes (LNs) o f the spleen hillus and along the splenic artery.Methods Pancreas and spleen involvement was retrospectively reviewed among 439 cases of resectable carcinoma of the gastric cardia,gastric corpus and total stomach. Du ring gastric surgery, 2 ml of methylene blue was injected into the subserosal sp ace of the gastric cardia or corpus to observe the spread of lymphatic flow in 5 4 cases of gastric carcinoma. The metastatic rate of LNs in splenic hillus and along the trunk of the splenic artery (No10, No11), postoperative complications and survival rates were investigated in 63 gastric carcinoma patients that had r eceived gastrectomy with pancreas and spleen preservation (PSP). These were com pared with the pancreas preservation (PP) group and pancreas and spleen combined resection (PSR) group.Results Among these 439 cases, only 25 cases were observed with direct invasion to the p ancreas (5.7%), and 10 cases with direct invasion to the spleen (2.3%). After pathological examination of the pancreatic body and tail, we found 22 cases wit h pancreas and spleen combined resection, 4 cases (18.2%, 4/22) with direct inv asion of the capsule and 2 with invasion to the superficial parenchyma (9.1%, 2 /22), without metastasis to the lymph nodes within the pancreas and spleen. The metastatic rate of No10,No11 lymph nodes were 17.5% (11/63) and 19.1% (12/63 ) in the PSP group, 20.8% (45/216) and 25%(54/216) in the PP group, and 20% (6/ 30) and 23.3% (7/30) in the PSR group. There were no statistically signific ant differences (P>0.05). Injection of methylene blue into the subserosal space of the stomach did not diffuse into the spleen or pancreatic parenchyma. Postoperative complications, diabetes and mortality in PSP (0%,0%,0%) were lowe r than in PP (4.2%, 0.9%, 0.9%) or PSR (40%,10%,3.3%). The 5-year surviva l rate (5-YSR) and 10-YSR in PSP (57.5%, 52.0%) were higher than in PSR (37 .5%,30.0%). Those patients with stage Ⅱ and Ⅲa treated by PSP, improved m arkedly.Conclusions The surgical procedure of pancreas and spleen preservation for gastric cancer is a safe and organ function protected method. Postoperative complications were l ower and survival rates were higher , the radicality was not reduced. These re sults indicate that PSP is preferred in patients with gastric carcinoma of stage Ⅱ or Ⅲa.关键词
胃癌/功能性根治手术/胰脾/脾脏Key words
gastric carcinoma/functional radical resection/pancreas/spleen分类
医药卫生
