直肠癌根治术切除标本中淋巴结检出数量分析  

A study on the number of lymph node harvested after radical resection of invasive rectal carcinoma

作　　者：王颢[1] 傅传刚[1] 曹傅傲[1] 龚海峰[1] 于恩达[1] 张卫[1] 刘连杰[1] 郝立强[1] 王汉涛[1] 孟荣贵[1] 

机构地区：[1]第二军医大学附属长海医院肛肠外科,上海200433

出　　处：《中华普通外科杂志》2009年第2期92-95,共4页Chinese Journal of General Surgery

基　　金：上海市科委课题“大肠癌早期诊断及综合治疗规范的研究”（No：07DZ1950）

摘　　要：目的研究未行术前新辅助治疗且无远处转移的直肠癌根治手术患者的淋巴结检出数量，探讨目前直肠癌淋巴结检出标准的合理性。方法对2000年1月至2008年6月收治的原发性结直肠癌（Ⅰ-Ⅲ期）患者的临床资料进行回顾性研究，比较直肠癌组和结肠癌组淋巴结检出数量。统计数据采用Mann-Whitney检验和χ^2检验。结果2282例结直肠癌患者入组，其中直肠癌1216例，结肠癌1066例（包括直肠乙状结肠交界癌）。直肠癌组与结肠癌组比较，直肠癌组淋巴结检出数量显著少于结肠癌组（9．4±0．1vs．10．5±0．1，P=0．000）；直肠癌组检出淋巴结达12枚者少于结肠癌组，差异有统计学意义（P=0．000）。两组性别比例无统计学差异（P=0．092），但直肠癌组年龄明显小于结肠癌组（P=0．000）。两组之间TNM分期无统计学差异（P=0．067）。依肿瘤距肛缘距离将直肠癌分为低位（距肛缘≤7cm）直肠癌组；中高位（距肛缘〉7cm，但≤15cm）直肠癌组，两组分别为834例（68．6％）和382例（31．4％）。结果显示低位直肠癌组淋巴结检出数量明显少于中高位直肠癌组（9．2±0．1vs．9．9±0．2，P=0．009），两组分别与结肠癌组比较，两组淋巴结检出数量均少于结肠癌组，差异有统计学意义（9．2±0．1vs．10．5±0．1，P=0．000；9．9±0．2vs．10．5±0．1，P=0．016）。结论对未行术前新辅助治疗、且无远处转移的直肠癌根治术患者，淋巴结检出数量少于结肠癌根治术患者。提示对直肠癌患者可能应设定不同于结肠癌的淋巴结检出标准。Objective To evaluate the number of lymph node harvested during radical resection of invasive rectal carcinoma （ stage Ⅰ to Ⅲ ）. Methods From January 2000 to June 2008, the pathological data of ealorectal carcinoma patients who were operated on were retrospectively reviewed. Exclusion criteria included recurrent colorectal tumor, Tis tumor, R1 or R2 resection, tumor resection transanally or endoscopieally, synchronous diseases affecting the surgical procedure for the rectal cancer （familial adenomatous polyposis, synchronous colorectal carcinoma ） and rectal cancer receiving perioperative neoadjuvant chemoradiation. Statistical analysis was performed using Mann-Whitney Test and Chi-Square Test （SPSS 15.0 ）. Results were expressed as mean ± SEM. Results A total of 2282 patients were identified, including 1216 cases in the rectal carcinoma group and 1066 cases in the colon carcinoma group. There were no significant difference in gender （719/1216 vs. 593/1066, P = 0. 092） and overall TNM stage （P =0. 067） between the two groups. But patients of rectal cancer were younger （58. 6 ±0. 4 vs. 62. 0 ± 0.4, P = 0. 000）. The lymph node retrieval in the rectal carcinoma group was significantly less than that of colon carcinoma group （9.4 ±0. 1 vs. 10. 5 ±0. 1, P =0. 000）. There were significantly less rectal cancer patients with a lymph node harvest equal to or more than 12 nodes （P = 0. 000）. Patients in the low rectal cancer group （ ≤7 cm from the anal verge, n = 834） had less lymph nodes harvested than the mid-high rectal cancer group （ 〉7cm and ≤15cm from the anal verge, n=382） （9.2±0.1 vs. 9.9±0.2, P= 0. 009）. Conclusion The lymph node harvest in the rectal carcinoma group was significantly less than that in the colon carcinoma group. A new standard may be necessary to define the adequate number of lymph nodes for rectal cancer.

关 键 词：结直肠肿瘤 手术 病理 淋巴结 

分 类 号：R686[医药卫生—骨科学]