直肠癌淋巴结转移规律及术中清扫范围的临床研究

Clinical Study on Lymph Node Metastasis of Rectal Carcinoma and Intraoperative Clearance Scope of Lymph Nodes

研究直肠癌患者淋巴结转移的规律及术中清扫数目与预后关系，回顾性分析258例行手术治疗的直肠癌患者的临床资料。检出淋巴结3096枚，在转移的188例患者中检出2256枚淋巴结，其中102例肿瘤在后壁，后壁肿瘤发现412枚中的235枚在直肠上动脉旁；肿瘤在侧壁51例，转移195枚中的36枚分布在直肠中动脉旁。结果表明，后壁直肠癌转移主要为上行扩散，侧壁直肠癌可伴有侧方淋巴结受累，并以肿瘤同侧淋巴结转移为主，充分的淋巴结切除可以改善直肠癌患者的预后。

The objective of the study was to analise the correlationship of lymph node metastasis of rectal carcinoma, the clearance number of lymph nodes and prognosis. The data of 258 rectal carcinoma cases who had undergone surgical treatment from Jan. 1998 to Des. 2004 were analised retrospectively. As results, 3096 lymph nodes were removedaltogether; 2256 lymph nodes were from the 188 cases who had had metastesis ,of which the rectal carcinoma was located in the posterior wall of the rectum in 102 cases,and of the 412 lymph nodes found in the posterior wall carcinomata 235 were located along the superior rectal artery;and in the other 51 cases,carcinoma was found in lateral wall,36 out of the 195 positive nodes were located around the middle rectal artery. It is revealed that the metastatic mode of upward spreading along the superior rectal artery, while carcinoma in the lateral wall may have lymph node involvement of lateral wall （mainly ipsilateral lymph node metastasis）. It is concluded that thorough clearance of the involved lymph nodes is of important measure on prognosis.