大肠癌淋巴转移规律与手术范围的关系

Colorectal cancer: lymphatic metastasis and choice of operation

目的 研究进展期结肠直肠癌淋巴结转移规律 ,指导手术根治范围。 方法 分析 74例结肠直肠癌行D3式根治术切除的淋巴结 62 3个 ,按肿瘤旁、肠管纵轴和中枢方向行淋巴结分组、分站 ,计算淋巴结转移率和转移度。 结果 肿瘤旁淋巴结转移率为 4 7 2 % ,转移度为 3 8 6% ,阳性淋巴结占 61 2 %。肠管纵轴方向淋巴结转移率为 2 2 8% ,转移度为 18 6% ,阳性淋巴结占 17 1% ,并与距肿瘤的距离和方向有关。中枢方向阳性淋巴结占 2 1 6% ,肠系膜淋巴结转移率为 2 0 % ,转移度为19 0 % ,肠系膜根部淋巴结转移率为 9 4 % ,转移度为 5 3 % ;直肠癌肛侧端距肿瘤 2 0cm以内淋巴结转移率为 3 7% ,2 0～ 4 0cm间未见转移 ,低位直肠癌侧方淋巴结转移率较高。 结论 进展期结肠直肠癌可向肠管纵轴和中枢方向转移 ,并且为低分化癌 ,肿瘤浸润深度超过pT2 者淋巴转移相应增多 ,跳跃式转移是一特点 ,宜行D3式廓清术 ;低位直肠癌力争行侧方加全直肠系膜淋巴结清扫术 ,行低位前距肿瘤下缘 2 0～ 3 0cm处切除 ,吻合口不易残留癌组织。

Objective To study lymphatic metastasis of colorectal cancer for deceding the of dissection extent of dissection. Methods Six hundred and twenty three lymph nodes from 74 cases of colorectal cancer were analyzed after D 3 resection. They were classified into peritumor, longitudinal spread, and upward spread groups. The metastasis rate of lgmph node and its incidence were calculated. Results The metastasis rate of lymph node and its incidence in the peritumor, longitudinal spread, and upward spread (N 2 and N 3) groups were 47 2% and 38 6%, 22 8% and 18 6%, and 29 7% (20 3% and 9 4%) and 10 2% (19 0% and 5 3%), respectively. The distribution rate of metastastic lymph node was 61 2%, 17 1%, and 21 6% in the peritumor, longitudinal spread, and upward spread groups, respectively. Within 2 0 cm on the anal side of rectal cancer, the metastasis rate was 3.7%, whereas in 2 0～4 0 cm no metastasis was observed cancer at the lower part of the rectum demonstrated a higher lateral metastasis rate. Conclusions Colorectal cancer tends to metastasize to longitudinal and the risk of metastasis increased in the stage of pT 3 and pT 4 or low differentiation stage. Jump metastasis is also a feature. D 3 radical resection is necessary for colorectal cancer, but extended lateral lymp node needs enectomy or total mesorectal excision. No residual tumor tissue exists at the anastomosis site after low anterior resection when the excision distance is beyond 2 0 cm from the anal margin of rectal cancer.