结肠癌肿瘤浸润范围和淋巴结转移的关系

Correlation between extent of the local infiltration and lymph node metastasis in colon carcinoma

目的探讨结肠癌的病灶部位、局部浸润与淋巴结转移之间的关系,为结肠癌外科手术方式的改进提供依据。方法结肠癌患者118例,其中行D2式淋巴廓清术者12例,D3式90例,D4式16例。用新鲜标本挤压触诊法行淋巴结检取。统计N1,N2,N3,N4站淋巴结的转移情况。肿瘤的浸润深度(T)按TNM分期。肠旁淋巴结分为距肿瘤上、下缘0～5cm,5～10cm以及>10cm3组。各组淋巴结转移的差异。结果淋巴结转移率为41.5%。共检取淋巴结1824个,其中有277个淋巴结发生转移,转移度为15.2%。3组肠旁淋巴结的转移率和转移度分别为34.7%,20.9%,2.5%和14.1%,1.7%,5.6%;0～5cm组与5～10cm组差异有显著性(P<0.05),5～10cm组与>10cm组的差异无显著性(P>0.05)。左半结肠癌淋巴结转移率为33.8%,其中肠旁淋巴结转移率为28.0%,中枢方向淋巴结转移率为19.1%。右半结肠癌的淋巴结转移率为52.0%,其中肠旁淋巴结转移率为52.0%,中枢方向淋巴结转移率为38.0%。右半结肠肿瘤淋巴结转移率尤其是向中枢方向的明显高于左半结肠(P<0.05)。按浸润深度统计T2,T3,T4组的N1,N2,N3,N4站淋巴结转移率分别为:18.2%,9.1%,4.5%,0%;40.8%,18.4%,8.2%,2.0%;53.8%,28.2%,12.8%,5.1%。结论N1～N4站淋巴结的转移率随肿瘤浸润深度的增加而增加(P<0.01)。结肠癌肠旁淋巴结的转移主要集中在距肿瘤上、下缘5cm以内的肠旁淋巴结,>10cm的肠旁淋巴结很少转移。右半结肠癌肠旁淋巴结及中枢方向淋巴结的转移率均高于左半结肠癌。随着结肠癌肿瘤浸润肠壁深度的增加,其淋巴结的转移率尤其是向中枢方向淋巴结的转移明显增加。结肠癌的手术应以D3术式为基本术式,重点要清扫向中枢方向转移的淋巴结,肠管切除的长度以距肿瘤上、下缘各10cm即可。

Objective To study the relationship of the site of original tumor and the local infihraton of colon carcinoma with lymph node metastasis, in order to provide a basis for better surgical therapy for patients with colon cancer. Methods The pathological and clinical data of 118 cases of the colon carcinoma were recorded and analyzed. The invasive depth of tumor was divided into T1 , T2 , T3 , and T4 stage according to AJCC standard. The lymph node stage was determind according to our country＇s and Japanese＇s standard. Results Of 118 cases, 49 cases （41. 5 % ） showed LN metastasis. In a total retrieved and examined 1824 LNS （ average of 15.29 lymph nodes per case） , 277 lymph nodes （ 15.2% ） showed metastasis. In three groups of the pericolon lymph nodes （Group 0 - 5 cm, Group 5 - 10 cm, and Group 〉 10 cm respectively from the tumor）, the metastatic rate of lvmDh nodes was 34. 7% . 2. 5% and 1. 7% .respectively. The metastatic rate of LN in right colon was significantly higher than that in left colon （ 52.0% vs 33.8%, P〈0.05）. All cases were divided into four groups （T1, T2, T3, and T4）, based on the depth of tumor invasion. The metastatic rate of N1,N2, N3 and N4 was 18. 2%, 9. 1%, 4. 5% and 0.0% in GroupT2; 40.8%,18.4%, 8.2% and 2.0% in GroupT3;The LN metastasis of and 53.8%, 28.2 % , 12.8 % and 5. 1% in Group T4 , respectively. There was significant difference among the group T2 , T3 , and T4 （ P 〈 0.01 ）. Conclusions As the depth of tumor invasion is increased, the metastatic rate of lymph nodes is markedly increased. The metastasis of pericolon lymph nodes is mainly in those nodes located within 0 -5 cm of the tumor, but rarely in those nodes located more than 10 cm from the tumor. The metastatic rate of lymph node in right colon cancer is significantly higher than that in left colon cancer. D3 radical resection is necessary for colon carcinoma and dissection of the central lymph nodes should especially be carried out. The length of excised bowel should be 10 cm above and below the tumor.