근치적 위 절제술에서 간-십이지장 인대 및 췌두 후부 림프절 절제술(D2+α)의 효과
Value of Hepatoduodenal Ligament and Retropancreatic Lymph Node Dissection (D2+α) in Gastric Cancer Surgery
김종서, 오성태, 이창환, 김용호, 육정환, 김병식, 박건춘,
소속 상세정보
김종서 ( Kim Jong-Seo )
울산대학교 의과대학 서울중앙병원 일반외과
오성태 ( Oh Sung-Tae )
울산대학교 의과대학 서울중앙병원 일반외과
이창환 ( Lee Chang-Hwan )
울산대학교 의과대학 서울중앙병원 일반외과학교실
김용호 ( Kim Yong-Ho )
울산대학교 의과대학 서울중앙병원 일반외과
육정환 ( Yook Jeong-Hwan )
울산대학교 의과대학 서울중앙병원 일반외과
김병식 ( Kim Byung-Sik )
울산대학교 의과대학 서울중앙병원 일반외과
박건춘 ( Park Kun-Choon )
울산대학교 의과대학 서울중앙병원 일반외과학교실
KMID : 0371320010610050504
Abstract
Purpose : Obstructive jaundice is a rare presentation in patients undergoing curative gastrectomy for gastric cancer. It is most commonly caused by lymphatic metastasis in the lymph nodes around the head of the pancreas and hepatoduodenal
ligament, especially when advanced gastric cancer is located in the pyloric antrum. This incidence suggests that extended and systemic lymph node dissection maybe reduce the risk of the development of obstructive jaundice after gastrectomy. In
this
study we tried to evaluate the effectiveness of D2+α lymph node dissection in preventing obstructive jaundice during gastric cancer treatment.
Methods : Twenty-four patients who underwent D2+α lymph node dissection in the course of gastric cancer treatment at Asan Medical Center between June 1995 and May 1997 were retrospectively analyzed on the basis of medical records. The
mean
age
of the patients was 54 years, and the male to female ratio was 3.9：1.
Results : Four patients (16.6%) developed complications (Ed-perhaps you wish to insert here, "other than tumor recurrence") but these were not serious. Tumor recurrence developed in 11 patients, and obstructive jaundice was revealed in one
(4.1%)
of these. All recurrent patients were more than stage III (Ed-confirming that this means stage 4 or more) with the most common recurrence site being the peritoneum (72.7%). The mean duration from operation to recurrence and from recurrence to
death
was
13.9 months and 7.9 months, respectively.
Conclusion : It is possible (Ed- or slightly stronger, "It is apparent") that D2?α dissection provides no benefit in preventing obstructive jaundice, compared with other reports (Ed- i.e. ’in comparison with other studies’. I wonder if
you
don’t
intend, "compared with the efficacy of other treatment modalities"), and that the most common site of recurrence was the peritoneum.
키워드
위암; 2+α군 림프절절제; 폐쇄성황달; Gastric cancer; D2+αlymph node dissection; Obstructive jaundice;
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