| PrefaceThe surgical treatment of the stomach cancer already has the history of more than 100 years, in the early years, cutting off the partial part of gastric neoplasm is the main method.Enter this middle period of century, alonging with the thorough of study of pathology of stomach cancer, the experience of local strike of the stomach cancer and lymph node metastasis raises gradually, making the gradual aggrandizement of the surgical operation scope of the stomach cancer subsequently.Experience successively for few decades to investigate again and again and the experience summary, making resection of stomach gradually reasonably with the scope of lymph node close account sweeping, premising under radical cure, guarantee the sufferer's function and the life quantities.Currently, the surgical operation is still initial means that cures the stomach cancer, cutting off thoroughly of original focus of stomach cancer and clearing metastased the lymph node and treatment of subclinical focus were the three important part of the modern surgery treatment.In the few decades years, cutting off the total gastric neoplasm is still the main method for curing the stomach cancer with the thorough of study of operation.The rate of survival from 20 percent to about 60 percent,have been improved obviously after 5 operation years.Considering the reasons,one of the most reasons is that the rate of early stomach cancer could be found have been increased except the gradual advancement of remedial level.Medium-phase and terminal stomach cancer sufferer still have the great mass of propotion in the all in-patients, the rate of survival keep about 30 percent.so, It is a core question to improve cure rate and decrease mortality of medium-phase and terminal stomach cancer sufferer, and is a foreland investigative topic in home and overseas.It is more changer by Japanese General Rules for the Gastric Cancer Study(13th edition) than former editions.In this edition, D2 and D3 cleared operation range is broadener than in the 12th edition,For example,D2 cleared operation range is No.3,4d,5,6 and No.1,7,8a,9 lymph node,but in the thirteenth edition, No.11p,12a,14v must be cleared beside of above lymph node.However,the difference of regionally and case specialty spur to discuss the rationality of new edition General Rules for the Gastric Cancer Study and standardizative D2 operation,and whether is appropriate method for our stomach cancer patients or not.Hence,we observed774 cases lymph node metastasis in the lower third of gastric carcinoma in the tumour section of the affiliated No.1 hospital of china medical university,discussed the disciplinarian of lymph node metastasis,and this study may be provide the scientific and exact clinical foundation for after-operation TNM stages and synthetical therapy.Objects and Methods1. Objects:There were 360 cases in D2 cutting off the total gastric neoplasm and 377 cases in before D2 cutting off the total gastric neoplasm in the tumour section of the affiliated No.1 hospital of china medical university from 1990 to 1999;397 suferers were practiced D2 cutting off the total gastric neoplasm.Thereinto, lymph node metastasis positive have 774 cases.According to General Rules for the Gastric Cancer Study(13th edition),397 patients were pratised D2 lymph node clearing opentions,360 invalids also were processed the same operations in accord with the twelfth edition.538 cases were mankind,236 cases were female,average age was 58 years old.The most tumor diameter less than 5 centimeter had 207 cases,amount or excess 5 centimeter had 567 cases, early stomach cancer:28 cases;evolving stomach cancer:746 cases. Borrmann 1 type:7cases; Borrmann 2 type: 198 cases; Borrmann 3 type:529 cases; Borrmann 4 type: 40cases. Eroding depth: T1 15 cases, T2 370 cases, T3 345 cases, T4 44 cases; Vegetal mode:gobbet and nest figure:442 cases;suffusion figure:332 cases;TNM stages:â… b: 25 cases,â…¡:298 cases,â…¢a:347cases,â…¢b:64 cases,â…£:38 cases。2. Methods:Clinical pathological sample accord to Japanese General Rules for the Gastric Cancer Study(13th edition) to deal with, D2 clearing operation is to clear the first station No.3,No.4d,No.5,No.6 and the second station No. 1,No.7,No.8a,No.9,No.11p,No.12a,No.14v lymph node,removing cancer focus and deposited lymph node into 10% formaldehy-de,fixation,slice up,routine H E dye, observing pathological configuration. We analysed data with single factor methord in accordance with the sex,age,main cancer location,cancer spot range, Borrmann type,corroding depth, growing mode, tissue type, vein eroding, lymphoid tube cancer bolt,broken leftover, complete extent, stomach removal range, whether eroding others organ or not,whether organs removaled associate with lymph node metastasis or not of sufferers.397 cases were carried out D2 lymph nodecleaing operations go by Japanese General Rules for the Gastric Cancer Study(13th edition),thus D2 operation comparing with non-D2 with in hospital time,operating time,bleed volume and afteroperation syndromes.3. Statistic analyze:The positive lymph node metastasis of every group were analysed by linear correlation. Microsoft excel 2003 and spss10.0 statistical software wereused by author for statistical analysis. X2-test was used to analyse the rate of positive lymph node metastasis among groups.LR method was used in excessive factors analysis.That have statistical meaning with P＜0.05.Experimental Results1. Lymph node metastases were found most frequently in groupâ… and â…¡, specially in No.6. Some metastasized to No.11p, No.12a No.14v.2. The separate dangerous elements of No.11p lymph node metastasis is that have lymphoid tube cancer bolts and No.1,No.3 lymph node metastasis.3. The separate dangerous elements of No.12 lymph node metastasis is that No.7 and No.8 have lymph node metastasis.4. The separate dangerous elements of No.14v lymph node metastasis is that have lymphoid tube cancer bolts and No.7,No.8 lymph node metastasis.5. The average in patient time of D2 team and non-D2 team respectively were: 18.4±37.9 days, 21.6±28.1 days;bleeding volume respectively were:240.2±212.2ml(D2 team), 295.6±196.7ml(non-D2team); average operation time respectively were: 236.3±72.5min, 172.4±64.5min. No significant difference exits between the two teams(P＞0. 05). The mean operation time of D2team was significantly longer than that in non-D2team(236. 3±72.5) minutes vs (172.4±64.5) minutes (P＜0.05). Syndromes manifest: D2 group:23 cases, non-D2team:19 cases. Thereinto,death (0,1), anastomose fistula(5,4), lymph fistula(3,2),celiac bleeding(4,2), celiac infection (3,4),cut infection(5,4), stomach nontension(3,3).Conclusions1. Extended lymphadenectomy should be performed in the lower third of gastric carcinoma.2. After cancer cells metastasized to groupâ… , No. 7 and No. 8a in groupâ…¡were the most frequenlly positive nodes.3. The scope of lymphadenectomy defined by Japanese General Rules for the Gastric Cancer Study(13lh edition)is sufficient.Dissection of No.11p, No.12a, No.14v in some cases is necessary.4. No significant clinical therapy and operation risk exits in the new criterion D2 operation.
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