• 吉林大學(xué)中日聯(lián)誼醫(yī)院胃腸外科（長(zhǎng)春 130033）;

目的  探討進(jìn)展期近端胃癌根治術(shù)聯(lián)合脾臟切除術(shù)的合理適應(yīng)證。
方法  選取我院自2005年3月至2008年2月期間50例進(jìn)展期近端胃癌行全胃切除患者為研究對(duì)象，根據(jù)脾臟是否切除分為切脾組（n=18）和保脾組（n=32）,比較2組患者間手術(shù)時(shí)間、住院時(shí)間、術(shù)后并發(fā)癥以及脾門淋巴結(jié)轉(zhuǎn)移情況。
結(jié)果  切脾組手術(shù)時(shí)間、住院時(shí)間和膈下感染發(fā)生率均明顯高于保脾組（P lt;0.05）。切脾組與保脾組術(shù)后病理檢查出的第10、11組淋巴結(jié)轉(zhuǎn)移率的差異無統(tǒng)計(jì)學(xué)意義（P gt;0.05）。
結(jié)論  進(jìn)展期近端胃癌根治術(shù)時(shí)，脾臟和脾血管受侵是聯(lián)合脾臟切除的合理適應(yīng)證。

引用本文： 崔超,孫立波,舒振波,李永超,丁大勇,馮野,蓋保東,金殷植,趙吉生,鄭澤霖. 進(jìn)展期近端胃癌根治術(shù)聯(lián)合脾臟切除術(shù)適應(yīng)證的選擇. 中國(guó)普外基礎(chǔ)與臨床雜志, 2010, 17(1): 22-24. doi: 復(fù)制

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1. 孫立波, 李永超, 馮野, 等. 全胃切除術(shù)后改良Orr式RouxenY 食管空腸吻合術(shù)的臨床研究 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2008; 15(12): 917919.
2. Okinaga K, Iinuma H, Kitamura Y, et al. Effect of immunotherapy and spleen preservation on immunological function in patients with gastric cancer [J]. J Exp Clin Cancer Res, 2006; 25(3): 339349.
3. Noma K, Yamaguchi Y, Okita R, et al. The spleen plays an immunosuppressive role in patients with gastric cancer: involvement of CD62L+ cells and TGFbeta [J].Anticancer Res, 2005; 25(1B): 643649.
4. Nanthakumaran S, Fernandes E, Thompson AM, et al. Morbidity and mortality rates following gastric cancer surgery and contiguous organ removal, a population based study [J]. Eur J Surg Oncol, 2005; 31(10): 11411144.
5. Biffi R, Chiappa A, Luca F, et al. Extended lymph node dissection without routine splenopancreatectomy for treatment of gastric cancer: low morbidity and mortality rates in a single center series of 250 patients [J]. J Surg Oncol. 2006; 93(5): 394400.
6. Fatouros M, Roukos DH, Lorenz M, et al. Impact of spleen preservation in patients with gastric cancer [J]. Anticancer Res, 2005; 25(4): 30233030.
7. Zhang CH, Zhan WH, He YL, et al. Spleen preservation in radical surgery for gastric cardia cancer [J]. Ann Surg Oncol, 2007; 14(4): 13121319.
8. Shen JG, Cheong JH, Hyung WJ, et al. Adverse effect of splenectomy on recurrence in total gastrectomy cancer patients with perioperative transfusion [J]. Am J Surg, 2006; 192(3): 301305.
9. Kunisaki C, Makino H, Suwa H, et al. Impact of splenectomy in patients with gastric adenocarcinoma of the cardia [J]. J Gastrointest Surg, 2007; 11(8): 10391044.
10. Yu W, Choi GS, Chung HY. Randomized clinical trial of splenectomy versus splenic preservation in patients with proximal gastric cancer [J]. Br J Surg, 2006; 93(5): 559563.
11. Kunisaki C, Shimada H, Ono H, et al. Predictive factors for pancreatic fistula after pancreaticosplenectomy for advanced gastric cancer in the upper third of the stomach [J]. J Gastrointest Surg, 2006; 10(1): 132137.
12. McCulloch P, Niita ME, Kazi H, et al. Gastrectomy with extended lymphadenectomy for primary treatment of gastric cancer [J]. Br J Surg, 2005; 92(1): 513.
13. Kikuchi S, Nemoto Y, Natsuya K, et al. Which patients with advanced, proximal gastric cancer benefit from complete clearance of splenopancreratic lymph nodes [J]. Anticancer Res, 2002; 22(6B): 35133517.
14. Weitz J, Jaques DP, Brennan M, et al. Association of splenectomy with postoperative complications in patients with proximal gastric and gastroesophageal junction cancer [J]. Ann Surg Oncol, 2004; 11(7): 682689.
15. Yamamoto M, Baba H, Kakeji Y, et al. Postoperative morbidity/mortality and survival rates after total gastrectomy, with splenectomy/pancreaticosplenectomy for patients with advanced gastric cancer [J]. Hepatogastroenterology, 2004; 51(55): 298302.
16. Ohno M, Nakamura T, Ajiki T, et al. Procedure for lymph node dissection around splenic artery in proximal gastric cancer [J]. Hepatogastroenterology, 2003; 50(52): 11731177.
17. Carboni F, Lepiane P, Santoro R, et al. Extended multiorgan resection for T4 gastric carcinoma: 25year experience [J]. J Surg Oncol, 2005; 90(2): 95100.
18. Ikeguchi M, Kaibara N. Lymph node metastasis at the splenic hilum in proximal gastric cancer [J]. Am Surg, 2004; 70(7): 645648.
19. Csendes A, Burdiles P, Rojas J, et al. A prospective randomized study comparing D2 total gastrectomy versus D2 total gastrectomy plus splenectomy in 187 patients with gastric carcinoma [J]. Surgery, 2002; 131(4): 401407.
20. Bisharat N, Omari H, Lavi L, et al. Risk of infection and death among postsplenectomy patients [J]. J Infect, 2001; 43(3): 182186.
21. Yang K, Chen XZ, Hu JK, et al. Effectiveness and safety of splenectomy for gastric carcinoma: a metaanalysis [J]. World J Gastroenterol, 2009; 15(42): 53525359.
22. Sasada S, Ninomiya M, Nishizaki M, et al. Frequency of lymph node metastasis to the splenic hilus and effect of splenectomy in proximal gastric cancer [J]. Anticancer Res, 2009; 29(8): 33473351.
23. Oh SJ, Hyung WJ, Li C, et al. The effect of spleenpreserving lymphadenectomy on surgical outcomes of locally advanced proximal gastric cancer [J]. J Surg Oncol, 2009; 99(5): 275280.
24. 何運(yùn)勝, 姜淮蕪. 進(jìn)展期胃癌多模式治療的研究進(jìn)展 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2008; 15(1): 3135.
25. 胡建昆, 陳志新, 張波, 等. 胃癌根治術(shù)中No. 8 淋巴結(jié)清掃的意義和技巧 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2007; 14(5): 560563.
  1. 1. 孫立波, 李永超, 馮野, 等. 全胃切除術(shù)后改良Orr式RouxenY 食管空腸吻合術(shù)的臨床研究 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2008; 15(12): 917919.
  2. 2. Okinaga K, Iinuma H, Kitamura Y, et al. Effect of immunotherapy and spleen preservation on immunological function in patients with gastric cancer [J]. J Exp Clin Cancer Res, 2006; 25(3): 339349.
  3. 3. Noma K, Yamaguchi Y, Okita R, et al. The spleen plays an immunosuppressive role in patients with gastric cancer: involvement of CD62L+ cells and TGFbeta [J].Anticancer Res, 2005; 25(1B): 643649.
  4. 4. Nanthakumaran S, Fernandes E, Thompson AM, et al. Morbidity and mortality rates following gastric cancer surgery and contiguous organ removal, a population based study [J]. Eur J Surg Oncol, 2005; 31(10): 11411144.
  5. 5. Biffi R, Chiappa A, Luca F, et al. Extended lymph node dissection without routine splenopancreatectomy for treatment of gastric cancer: low morbidity and mortality rates in a single center series of 250 patients [J]. J Surg Oncol. 2006; 93(5): 394400.
  6. 6. Fatouros M, Roukos DH, Lorenz M, et al. Impact of spleen preservation in patients with gastric cancer [J]. Anticancer Res, 2005; 25(4): 30233030.
  7. 7. Zhang CH, Zhan WH, He YL, et al. Spleen preservation in radical surgery for gastric cardia cancer [J]. Ann Surg Oncol, 2007; 14(4): 13121319.
  8. 8. Shen JG, Cheong JH, Hyung WJ, et al. Adverse effect of splenectomy on recurrence in total gastrectomy cancer patients with perioperative transfusion [J]. Am J Surg, 2006; 192(3): 301305.
  9. 9. Kunisaki C, Makino H, Suwa H, et al. Impact of splenectomy in patients with gastric adenocarcinoma of the cardia [J]. J Gastrointest Surg, 2007; 11(8): 10391044.
  10. 10. Yu W, Choi GS, Chung HY. Randomized clinical trial of splenectomy versus splenic preservation in patients with proximal gastric cancer [J]. Br J Surg, 2006; 93(5): 559563.
  11. 11. Kunisaki C, Shimada H, Ono H, et al. Predictive factors for pancreatic fistula after pancreaticosplenectomy for advanced gastric cancer in the upper third of the stomach [J]. J Gastrointest Surg, 2006; 10(1): 132137.
  12. 12. McCulloch P, Niita ME, Kazi H, et al. Gastrectomy with extended lymphadenectomy for primary treatment of gastric cancer [J]. Br J Surg, 2005; 92(1): 513.
  13. 13. Kikuchi S, Nemoto Y, Natsuya K, et al. Which patients with advanced, proximal gastric cancer benefit from complete clearance of splenopancreratic lymph nodes [J]. Anticancer Res, 2002; 22(6B): 35133517.
  14. 14. Weitz J, Jaques DP, Brennan M, et al. Association of splenectomy with postoperative complications in patients with proximal gastric and gastroesophageal junction cancer [J]. Ann Surg Oncol, 2004; 11(7): 682689.
  15. 15. Yamamoto M, Baba H, Kakeji Y, et al. Postoperative morbidity/mortality and survival rates after total gastrectomy, with splenectomy/pancreaticosplenectomy for patients with advanced gastric cancer [J]. Hepatogastroenterology, 2004; 51(55): 298302.
  16. 16. Ohno M, Nakamura T, Ajiki T, et al. Procedure for lymph node dissection around splenic artery in proximal gastric cancer [J]. Hepatogastroenterology, 2003; 50(52): 11731177.
  17. 17. Carboni F, Lepiane P, Santoro R, et al. Extended multiorgan resection for T4 gastric carcinoma: 25year experience [J]. J Surg Oncol, 2005; 90(2): 95100.
  18. 18. Ikeguchi M, Kaibara N. Lymph node metastasis at the splenic hilum in proximal gastric cancer [J]. Am Surg, 2004; 70(7): 645648.
  19. 19. Csendes A, Burdiles P, Rojas J, et al. A prospective randomized study comparing D2 total gastrectomy versus D2 total gastrectomy plus splenectomy in 187 patients with gastric carcinoma [J]. Surgery, 2002; 131(4): 401407.
  20. 20. Bisharat N, Omari H, Lavi L, et al. Risk of infection and death among postsplenectomy patients [J]. J Infect, 2001; 43(3): 182186.
  21. 21. Yang K, Chen XZ, Hu JK, et al. Effectiveness and safety of splenectomy for gastric carcinoma: a metaanalysis [J]. World J Gastroenterol, 2009; 15(42): 53525359.
  22. 22. Sasada S, Ninomiya M, Nishizaki M, et al. Frequency of lymph node metastasis to the splenic hilus and effect of splenectomy in proximal gastric cancer [J]. Anticancer Res, 2009; 29(8): 33473351.
  23. 23. Oh SJ, Hyung WJ, Li C, et al. The effect of spleenpreserving lymphadenectomy on surgical outcomes of locally advanced proximal gastric cancer [J]. J Surg Oncol, 2009; 99(5): 275280.
  24. 24. 何運(yùn)勝, 姜淮蕪. 進(jìn)展期胃癌多模式治療的研究進(jìn)展 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2008; 15(1): 3135.
  25. 25. 胡建昆, 陳志新, 張波, 等. 胃癌根治術(shù)中No. 8 淋巴結(jié)清掃的意義和技巧 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2007; 14(5): 560563.