进展期直肠癌淋巴结转移状况与根治术的关系

Relationship between Lymphatic Metastasis and Extent of Radical Operation in Advanced Rectal Cancer

研究进展期直肠癌淋巴结转移状况，指导手术根治范围。方法：76例直肠癌患者行D3式根治术，按肿瘤旁、肠管纵轴和中枢方向行淋巴结分组，检测侧方和腹膜返折下直肠周围系膜转移淋巴结数，并计算淋巴结转移率。结果：肿瘤旁和肠管纵轴方向边缘动脉旁淋巴结转移率分别为39.5%和9.2%，肛侧端距肿瘤<2cm肠管纵轴旁淋巴结转移率为2.6%，>2cm未见转移；沿肠系膜下血管中枢方向淋巴结转移率为18.4%，而肠系膜下动脉(IMA)根部淋巴结转移率为10.5%；侧方淋巴结转移率为11.8%，腹膜返折下直肠周围系膜淋巴结转移率为12.5%。结论：进展期直肠癌可向肠管纵轴和中枢方向淋巴结转移。腹膜返折下直肠癌有侧方淋巴结转移并侵及直肠周围系膜，肿瘤浸润深度超过pT2期和低分化癌者淋巴结转移相应增多。宜行IMA根部结扎整块切除的D3式廓清术，腹膜返折下直肠癌力争行侧方淋巴结清扫和全直肠系膜切除术。

To study the relationship between lymphatic metastasis and extent of radical operation in advanced rectal cancer. Methods: Seventy-six consecutive cases of rectal cancer subjected to D3 lymphadenectomy were analyzed retrospectively. Lymph nodes were classified as paratumoral regional and at the root of IMA, and for tumors below the peritoneal reflection, lymph nodes(LN) situated in the lateral ligament and mesorectum were examined as well. The metastatic rate was analyzed statistically. Results: The rate of metastasis was 39.5%, 9.2% and 18.4% in the paratumoral, regional and the root of IMA respectively. The rate of LN metastasis in lesions with distal margin<2cm to the anus was 2.6%, while no metastasis was found in those with distal margin>2.0cm from the anus. The metastatic rate of LNs around the root of IMA was 10.5%. The metastatic rate of LNs in the lateral ligament and in the mesorectum for tumors below the peritoneal reflection were 11.8% and 12.5%. Conclusions: In advanced rec-tal cancer below the peritoneal reflection, LNs tend to metastasize along the related blood vessels proximally, laterally and to the mesorectum. Extended lateral lymphadenectomy and total mesorectal excision(TME) should be included in cases below the peritoneal reflection.