右半结肠癌淋巴结转移规律及其临床意义

Principle of metastatic lymphatic nodes in right colon cancer and its clinical significance

目的研究右半结肠癌淋巴转移规律,指导手术根治范围。方法收集1997年1月至2000年12月根治性切除76例右半结肠癌患者的病理资料,按日本结直肠癌临床病理约定(JGR)进行淋巴结分组、分站,分析右半结肠癌的淋巴转移规律。结果76例患者有淋巴结转移者49例,转移率645%;转移淋巴结184个,转移度171%。N1组淋巴结转移率、转移度、阳性淋巴结分布率分别为632%、215%、533%,N2组为395%、165%、342%,N3组为158%、90%、109%,N4组为39%、15%、16%。N1站98个阳性淋巴结沿肠管纵轴分布距肿瘤5cm以内、5～10cm、10～15cm、15～20cm各占684%、296%、10%、10%,20cm以上无阳性淋巴结;10cm内外有明显的差异。淋巴转移和结肠癌的组织学类型、浸润深度、肿瘤大小有明显的相关关系。本组发生淋巴结跳跃式转移者10例,主要见于组织学分化较差、肿瘤较大、浸润较深者,尤其是肿瘤浸润深度达pT3者。跳跃式转移的形式以N1+～N2-～N3+为主。结论右半结肠癌淋巴转移主要向中枢方向转移;对低分化癌、肿瘤浸润超过pT3者主张把D3式淋巴结廓清作为标准术式;切除结肠肠管的长度以距肿瘤20cm以上为宜。

Objective To explore the principle of lymphatic metastasis of right colon cancer in order to guide the radical resection.Methods Pathological data of 76cases with right colon cancer were analyzed.The lymphatic nodes were classified by Japanese Clinical Pathological R ules of colon cancer.The principle o f the lymphatic metastasis was investigated.Results Metastatic lymphatic nodes were fou nd in 49cases among76cases with colon cancer.The metastatic rate was 64.5%.There were tota lly 184metastatic lymphatic nodes with the metastatic incidence of 17.1%.The metastatic rate,incidence a nd distribution rate of the lymphati c nodes determined in the classification of N 1 were 63.2%,21.5%,53.3%,of N 2 39.5%,16.5%,34.2%;of N 3 15.8%,9%,10.9%;and of N43.9%,1.5%,1.6%respectively.The percentage of 98positive lymphatic nodes spread longitudinally within5cm,from5to 10cm,from 10cm to 15cm,from15cm to 20cm distance to the tumor,were 68.4%,29.6%,1.0%and 1.0%.No positive lymphatic node was found beyond 20cm distance to the cancer.There was sig nificant difference of the percenta ge of the positive nodes between with in 10cm and beyond 10cm distance to the tum or.The metastasis of lymphatic nodes was associated with tissue type,invasive deepness,and tumor size.J ump metastasis occurred in 10cases,of which the tumor was poorly differentiated,large and deeply in vasive,especially with pT 3 .Jump metastasis mainly demonstrated N 1 (+)～N 2 (-)～N 3 (+).Conclusions Metastasis of lymphatic nodes in rig ht colon cancer frequently spreads longitudinally.D 3 radical resection should be perform ed for the tumor with poorly differen tiation and invasion above pT 3 .The range of the bowel resection should be beyond 20cm distance to the tum or.