462例中下段直肠癌淋巴转移规律与淋巴清扫范围的分析

Patterns of lymph node metastasis and extent of lymph node dissection for middle or lower rectal cancer: analysis of 462 cases

目的 探讨中下段直肠癌的淋巴转移规律和淋巴清扫范围。 方法 对 1990～ 1999年行传统直肠癌根治术的 373例和行传统直肠癌根治术加盆腔侧方淋巴清扫术 (简称侧方清扫术 )的89例中下段直肠癌患者进行回顾性分析。 结果 全组淋巴转移率为 41 8% ,患者年龄、癌灶浸润深度、大体分型、癌灶大小是影响淋巴转移率的重要因素 (P <0 0 5 )。 89例侧方清扫术的盆腔侧方淋巴转移率为 15 7% ,其中 85 7%位于癌灶同侧。有盆腔侧方淋巴转移者均为浸润深度T3 、T4 者 ;癌灶>3cm、溃疡型或浸润型、年龄 <6 0岁者盆腔侧方淋巴转移率较高。侧方清扫术组的盆腔复发率为5 6 % ,明显低于传统直肠癌根治术组的 17 7% (P <0 0 5 ) ;侧方清扫术组和传统直肠癌根治术组的 5年生存率分别为 46 7%和 47 9% (P >0 0 5 )。 结论 应提高对中下段直肠癌淋巴转移规律的认识 ,对怀疑或证实有淋巴结转移、癌灶侵犯浆膜或穿透肠壁、癌灶 >3cm、溃疡型或浸润型、年龄 <6

ObjectiveTo study the patterns of lymph node metastasis and discuss extent of lymph node dissection for middle and lower rectal cancer. Methods Clinical data on 373 patients with middle or lower rectal cancer undergoing conventional radical resection (CRR) and other 89 receiving lateral pelvic lymphadenectomy (LPL) in our department from 1990 to 1999 were retrospectively analyzed. Results The overall rate of lymph node metastasis was 41 8%. Age, depth of tumor invasion, gross type and tumor size significantly affected the lymph node metastasis ( P <0 05). In the 89 patients receiving LPL, the rate of lateral lymph node metastasis of the tumor was 15 7% and 85 7% of the metastases located on the same side of the tumor. All those patients with lymph node metastasis suffered from T3 or T4 tumor. The rate of lateral metastasis was higher in patients aged less than 60, ulcerative or infiltrative tumor or a tumor more than 3 cm. The pelvic recurrance rate was markedly lower in patients treated with LPL (5 6%) than in those with CRR (17 7%) ( P <0 05). In addition, the 5 year survival rate was 46 7% and 47 9% in patients treated with LPL and those with CRR, respectively ( P >0 05). Conclusions In patients with middle or lower rectal cancer, LPL is necessary for those with suspected or confirmed lymph node metastasis, T3 or T4 tumor and ulcerative or infiltrative tumor, and a tumor more than 3 cm or an age less than 60.