直肠癌淋巴结转移规律及其根治术中的合理切除

The lymph node metastases patterns in the mesorectum and reasonable radical resection of rectal cancer

背景与目的:直肠癌是消化道最为常见的恶性肿瘤之一,淋巴转移是常见的转移途径,也是导致复发而致死亡的重要原因。本研究探讨直肠癌淋巴结转移规律与直肠癌根治术的合理切除范围。方法:2004年9月—2005年9月于本院普外科胃肠专业组的接受直肠癌根治术27例患者,系膜淋巴结及侧方淋巴结分为10组,送检。结果:共取出淋巴结555个,癌浸润99个,其中肿瘤旁267个,癌浸润72个;肿瘤近端165个,癌浸润21个;肿瘤远端75个,无癌浸润;侧方48个,癌浸润6个。44%有淋巴结转移,11%发生侧方淋巴结转移,直肠癌淋巴结转移肿瘤旁为主,癌浸润淋巴结肿瘤旁占72.7%,近端为21.2%,侧方6.06%,肿瘤远端未见癌浸润淋巴结。结论:直肠癌的淋巴转移以肿瘤旁为主,为保肛低位直肠癌远端切除1～2cm是可行的。

Background and purpose： Rectal cancer is one of the most common digestive tract malignant tumors. Lymph node was one of the common site of metastasis, and mainly account for local failure.. This study was to investigate the patterns of lymph node （LN） mestastases and reasonable resection of rectal cancer. Methods： From September 2004 to September 2005, 27 patients with rectal cancer was treated with radical surgery and all the lymph nodes was examined by pathology and immunohistochemical staining. Results： A total of 555 lymph nodes were harvested, 99 lymph nodes in 27 cases found positive. 72 lymph nodes in 267 lymph nodes in the paratumoral region were found positive. 21 lymph nodes in 165 lymph nodes in the proximal tumoral region were found positive. No lymph nodes metastasis were found in 75 lymph in the distal tumoral region. 6 lymph nodes in 48 lateral lymph nodes were found positive. Lymph nodes metastasis was observed in 44% patients, lateral lymph nodes metastasis was observed in 11% patients.The metastasis rate in the paratumoral was 72.7%. The positive LN percentage in the proximal tumoral was 21.2%. The positive LN percentage in the lateral tumoral was 6.06%. No positive lymph nodes were found in distal tumoral region. Conclusion： The lymph node of the paratumoral region was the main site of metastasis. It is practicable to resect 1-2cm distal to the tumor to preserve the anus.