摘要
日本《胃癌处理规约》把与胃癌转移相关的淋巴结分组标记,使外科与病理科医生按统一的规范进行操作,获得每一病例转移淋巴结的分布情况。通过大量病例总结出淋巴结转移规律与途径,为胃癌根治术奠定理论基础。《胃癌处理规约》由简到繁,再到细致化与扩大化:分出亚组研究以使淋巴结清扫更趋合理;扩大标记范围研究以探索扩大手术对提高疗效的作用。数十年来的研究把淋巴结转移规律探索到了极致,也使手术治疗胃癌的效果几近极限。因此,日本学者把成熟的治疗模式建立为《胃癌治疗指南》后不久,2010年修订的《胃癌处理规约》就将胃癌由按转移淋巴结所在位置分期改为按转移个数分期,表明对胃癌手术方式的探索已经告一段落,今后胃癌治疗效果的提高有赖于综合治疗。胃癌根治术的形成是多学科协作研究的结果,手术仍是治疗胃癌的主要方法,应严格按照规范操作,术后淋巴结分组送检对于判定手术效果与预后具有重要意义。
Japanese gastric cancer classification marks the lymph nodes associated with gastric cancer metastasis in groups, which allows the surgeons and pathologists to operate as per a uniform specification to obtain the distribution of metastatic lymph nodes in every case. Through a substantial number of cases, the rules and pathways of lymph node metastasis are summarized, thus laying a theoretical foundation for radical gastrectomy. From the simple to the complex, and then to the refined and expansive, the classification categorizes subgroup studies to better rationalize the lymph node dissection;and expands the researches on marker range to investigate the role of enlarged surgery. Researches over decades have explored the law of lymph node metastasis to the extreme, and the surgical efficacy of gastric cancer near limit. Thus, shortly after the mature treatment model was established as the Gastric Cancer Treatment Guidelines by Japanese experts, the revised classification in 2010 altered the criterion for staging gastric cancer from the location of metastatic lymph nodes to the number of metastases. This indicates that the exploration of surgical approaches to gastric cancer is basically completed, and the future efficacy improvement of gastric cancer depends on comprehensive therapy. The formation of radical gastrectomy is the result of multidisciplinary collaborative research. Surgery should still be performed in strict accordance with the specification. Postoperative grouped inspection of lymph nodes has great significance for determining the surgical outcome and prognosis.
作者
李国立
LI Guo-li(Department of Surgery, General Hospital of Eastern Theater Command, Nanjing 210002, China)
出处
《中国实用外科杂志》
CSCD
北大核心
2019年第1期75-78,共4页
Chinese Journal of Practical Surgery
关键词
胃癌
手术
规约
指南
综合治疗
gastric cancer
surgery
classification
guidelines
comprehensive treatment
