目的总结19例胃癌根治术后合并淋巴瘘的诊治经验。 方法对我院2001年1月至2010年3月期间204例胃癌根治术后19例发生淋巴瘘患者的临床资料进行回顾性分析。 结果19例中15例经非手术治疗治愈，4例因非手术治疗无效行手术探查，其中2例术后痊愈，另2例分别于术后第3天和第6天再次并发淋巴瘘，最终致全身多器官功能衰竭而死亡。 本组淋巴瘘发生率与患者性别、年龄及术前是否化疗无关（Pgt;0.05），但第7、8a、9和16组淋巴结同时有转移者高于无转移者、行D2+手术者高于行D2手术者、使用超声刀者高于未使用者、Ⅱ及Ⅲ期高于Ⅰ期（Plt;0.01），未使用生物蛋白胶者高于使用者、行早期肠内营养者高于晚期肠内营养者、胃中上部肿瘤高于胃下部肿瘤（Plt;0.05）。 TPN加用生长抑素及生长激素者腹腔引流量为（330±40） ml/d，均明显少于单用TPN 〔(750±140) ml/d〕及TPN加用生长抑素者〔(450±40) ml/d〕，Plt;0.01和Plt;0.05，后两者比较其差异也有统计学意义（Plt;0.05）。 TPN加用生长抑素及生长激素患者淋巴瘘的愈合时间为（13.1±1.5） d，较完全TPN的（25.6±2.1） d及TPN加用生长抑素的（18.3±7.1） d缩短，Plt;0.05，后两者比较的差异也有统计学意义（Plt;0.05）。 结论胃癌根治术中可靠结扎淋巴管、避免过度扩大淋巴结清扫范围以及避免早期的肠内营养对预防术后淋巴瘘极为重要。
ObjectiveTo evaluate the prognostic significance of metastatic lymph nodes ratio (MLNR) in patients with node-positive breast cancer. MethodsThe clinical data of 94 patients with nodepositive breast cancer underwent modified radical mastectomy were retrospectively analyzed. The survival rate and prognosis factors of patients with complete follow-up data were assessed by log-rank test and multivariate regression analysis. Results The survival time of 94 patients ranged from 12-75 months, with median 64 months. The 5-year overall survival rate was 72.34% (68/94). The total MLNR was 0.31 (486/1 553). Univariate analysis demonstrated that the survival was influenced significantly by tumor size, number of lymph node metastasis, MLNR, ER status, and radiotherapy or not (Plt;0.05), but not by patient’s age, menopause or not, PR status, endocrine therapy or not, and histological type (Pgt;0.05). Multivariate analysis showed that MLNR (OR=2.565, 95%CI=1.043-6.309， P=0.040) and tumor size (OR=2.220, 95%CI=1.045-4.716， P=0.038) were independent prognostic factors for the patients with node-positive breast cancer. Conclusion MLNR is a major independent prognostic factor for the patients with node-positive breast cancer, which is more accurate than the number of metastatic lymph nodes in predicting the survival of patients with node-positive breast cancer.
ObjectiveTo observe the outcome of left lung cancer underwent surgical treatment and to analysis the relative risk factors for 4L lymphatic metastasis. MethodsWe retrospectively analyzed the clinical data of 643 lung cancer patients who had underwent mediastinal lymph node dissection intraoperatively in our hospital between January 2011 and December 2013. There were 430 males and 213 females with a mean age of 60.2±9.6 years(range 22 to 83 years), 260 patients had their 4L lymph node dissected, while other 383 patients did not. ResultsAmong 260 patients with 4L lymph node dissected, 44(16.9%) were found 4L lymph node metastasis pathologically. And the results indicated that station 5 lymph node metastasis(P=0.000, OR=12.108 with 95%CI 4.564 to 32.122), station 7 lymph node metastasis(P=0.000, OR=8.496 with 95%CI 2.594 to 27.827), station 8 lymph node metastasis(P=0.029, OR=24.915 with 95%CI 1.395 to 444.948), station 10 lymph node metastasis(P=0.014, OR=3.983, 95%CI 1.321 to 12.009) were independently associated with high risk for 4L lymph node metastasis. Conclusion4L lymphadenectomy should be performed for left invasive lung cancer regularly, especially for patients with hilar lymph node and other mediastinal lymph node metastasis.
Objective This study analyzed the pattern and influence factors of lymph node metastasis in thoracic esophageal cancer to provide a reference for the lymph node dissection for esophageal cancer. Methods Clinical data of 177 patients with thoracic esophageal cancer receiving the lymph node dissection in our department from 2015 to 2016 were retrospectively analyzed. There were 125 males and 52 females with a median age of 64 years, ranging from 18 to 86 years. We excluded cervical esophageal cancer and adenocarcinoma of the esophagogastric junction and analyzed the relationship between lymph node metastasis and tumor pathological type, depth of invasion, degree of differentiation and length. Results Of the 177 patients, 76 (42.9%) were found to have lymph node metastasis. In the 4 977 dissected lymph nodes, metastasis was identfied in 361 (7.3%) lymph nodes. The rate of lymph node metastasis in thoracic esophageal carcinoma was not related to the location and length of the tumor (P>0.05), but related to the depth of invasion and the degree of differentiation (P<0.05). Conclusion Lymph node metastasis is prone to present in the early stage of thoracic esophageal cancer. According to the characteristics of lymph node metastasis in thoracic esophageal carcinoma, we need have a standardized, systematic and focused lymph node dissection.
As a standard of care, lymph node dissection is an indispensible step in lung cancer surgery. The quality of dissection determines completeness of surgery and the accuracy of N staging. Hereby, we suggest labeling all surgically resected nodes according to the new lymph node map in the 8th TNM classification for lung cancer. As systematic lymph node dissection remains the gold standard of lymphadenectomy, at least three mediastinal stations and ten nodes should be removed in an en-bloc fashion, if possible. For patients with stage Ⅰ lung cancer, lymph node dissection via video-assisted thoracoscopic surgery (VATS) or open thoracotomy may has similar oncological outcome. Besides, limited lymph node sampling in selected patients with early staged lung cancer to minimize unnecessary surgical damage still need further investigation.