结、直肠癌淋巴引流区域的观察

The observation of lymph drainage area of Colorectal carcinoma

目的了解进展期大肠癌淋巴结癌转移情况,为临床大肠癌外科手术及重点部位防治提供科学依据。方法2002年8月-2004年4月期间我院外科手术治疗的乙状结肠、直肠上段癌30例患者,根治性切除术中经瘤前动脉注射染色剂显示着色区域,着色区域淋巴结清扫并送检,分析淋巴结转移特点。结果乙状结肠癌为一向心性扇形着色区,癌肿两端6-10cm肠段沿系膜至肠系膜下动脉区域;直肠上段癌着色区域分为三个部分,第一部分为癌肿两端3-6cm肠段以及沿肠系膜下动脉至腹主动脉分枝处,第二部分为盆底腹膜及部分膀胱表面腹膜,第三部分为髂血管区域。乙状结肠、直肠上段癌着色区内淋巴结转移率分别为52．5％及29．5％。结论进展期大肠癌淋巴结转移具有分布由近及远,阳性率从高到低的特点。瘤前动脉注射染色剂所着色区域是乙状结肠癌及直肠上段癌需要外科治疗及术后埋置给药的重点区域。

Objective observe the character of the lymph node metastasis in advanced large intestinal carcinoma. 30 Sigmoidocolic or rectal carcinoma with surgical intervention were enrolled. During ectomy, Coloring agent was injected in the anterior-tumor artery to display the pigmenting area. The lymph nodes in the pigmenting area were cleared and examined to analysis the character of the lymph node metastasis. Result The pigmenting area of sigmoidocolic carcinoma was sector from the bowel about 6-10cm of amphi-tumor to inferior mesenteric artery along mesentery. The pigmenting area of rectal carcinoma was divided 3 parts,The first part was the bowel about 3-6cm of amphi-tumor and the area from inferior mesenteric artery to the initiation of abdominal aorta branch,The second part was peritoneum of pelvic basement and partial peritoneum of bladder surface,the third part was iliac angiosomes. In the pigmenting area Sigmoidocolic or rectal carcinoma, the lymph node metastasis rate were 52,5% and 29.5%. Conclusion The character of the lymph node metastasis in advanced large intestinal carcinoma was the distribution of from recent to distant, positive rate of from high to low. The The pigmenting area of Sigmoidocolic or rectal carcinoma was important area needed surgical intervention and buried drug during surgical treatment.