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进展期结直肠癌淋巴转移规律的临床研究

CLINICAL STUDIES ON THE RULE OF LYMPHATIC METASTASIS FOR ADVANCED COLORECTAL CANCER

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【作者】 高友福姜波健孙荣勋沈浩涂长龄

【Author】 GAO You fu, JIANG Bo jian, SUN Rong xun, et al. Department of General Surgery, Shanghai Jing′an District Center Hospital, Shanghai 200040

【机构】 上海市静安区中心医院普外科!上海200040

【摘要】 目的 研究进展期结直肠癌淋巴结转移规律, 评价手术根治程度。方法 分析114 例结直肠癌行扩大的D3 式根治术后淋巴结1 005 个, 按肿瘤旁、肠管纵轴和中枢方向淋巴结分组分站。结果 肿瘤旁、肠管纵轴方向淋巴结转移率、转移度和阳性淋巴结分布率分别为43 .9 % 、37 .2 % 和58 .9 % 及32 .5 % 、15 .9 % 和17 .5 % , 口侧端有淋巴结转移大多在10 cm 以内, 而直肠癌肛侧端距肿瘤2 .0 cm 以内转移率为5 .5 % , 2 ~4 cm 处未见转移。中枢方向系膜、系膜血管根部淋巴结转移率和转移度分别为19 .3 % 和16 .6 % 及10 .5 % 和7 .8 % ; 中枢方向及肠管纵轴方向阳性淋巴结分布率分别为23 .5 % 和17 .5 % 。直肠乙状结肠部癌 (Rs) 、上部直肠癌( Ra) 和下部直肠癌 (Rb) 侧方淋巴结转移率分别为0 % 、8 .7 % 和12 .5 % 。结论 进展期结直肠癌有向肠管纵轴和中枢方向转移; 跳跃式转移是一特点。低位直肠癌离肛缘6 cm 以内, 浸润深度为pT3 及pT4 时, 其侧方淋巴结转移率较高。结肠癌宜行D3 式淋巴廓清, 直肠癌主张系膜下动脉根部结扎, 加行全直肠系膜切除和侧方淋巴结廓清术

【Abstract】 Objective To study the rule of lymphatic metastasis and to evaluate the extent of curative resection in advanced colorectal cancer. Methods One thousand and five lymph nodes from 114 consecutive patients with colorectal cancer underwent extended D 3 resection were analyzed and classified as peritumor, longitudinal, and upward spread distribution. Results The metastatic rate and incidence of lymph node metastasis in peritumor, longitudinal as well as upward spread (N 2 and N 3) was 43.9% and 37.2%, 32.5% and 15.9% as well as 29.8% (19.3% and 10.5%) and 12.1% (16.6% and 7.8%) respectively. The distribution rate of metastatic lymph nodes was 17.5% and 23.5% in the longitudinal and upward spread respectively. In the longitudinal spread, most of lymph node metastasis was seen within 10 cm. Within 2 cm on the anal side in rectal cancer, the metastasis rate was 5.5%, and there was no metastasis in 2-4 cm. The lateral metastasis rate was 0%, 8.7% and 12.5% in the rectosigmoid (Rs), upper rectum (Ra) and lower rectum (Rb) respectively. Conclusion Advanced colorectal cancer tend to metastasize to longitudinal and upward lymph nodes. Jump metastasis is also a feature. In the lower rectal cancer within 6 cm from the anal verge or beyond pT 3, there is a high risk of lateral metastasis. Extended D 3 radical resection is necessary for colic cancer, but high ligation of the inferior mesenteric artery root as well as lateral lymphadenectomy and total mesenteric excision should also be performed for rectal cancer. There is no residual tumor tissue in the anastomosis when the excision distance is beyond 2 cm from the anal margin in rectal cancer.

  • 【文献出处】 中国普外基础与临床杂志 ,CHINESE JOURNAL OF BASES AND CLINCS IN GENERAL SURGERY , 编辑部邮箱 ,2000年01期
  • 【分类号】R735.37
  • 【被引频次】35
  • 【下载频次】207
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