大肠癌淋巴转移规律对手术根治性的临床意义  

The rule of lymph metastasis of advanced colorectal cancer and its clinical significance for surgical approach

作　　者：高友福[1] 姜波健[1] 孙荣勋[1] 涂长龄[1] 

机构地区：[1]上海市静安区中心医院普外科,200040

出　　处：《中华普通外科杂志》2000年第2期98-101,共4页Chinese Journal of General Surgery

摘　　要：目的　研究进展期结直肠癌淋巴转移规律 ,指导手术根治范围。方法　分析 74例结直肠癌行D3式根治术后淋巴结 62 3个 ,按肿瘤旁、肠管纵轴和中枢方向行淋巴结分组、分站。结果　肿瘤旁淋巴结转移率和转移度最高各为 4 7%和 3 8 6% ,阳性淋巴结分布率为 61 2 % ;肠管纵轴方向淋巴结转移率为 2 3 % ,转移度为 18 6% ,阳性淋巴结分布率为 17 1% ,并与距肿瘤远近和方向有关 ;中枢方向阳性淋巴结分布率为 2 1 6% ,系膜淋巴结转移率为 2 0 % ,转移度为 19 0 % ,系膜根部淋巴结转移率为 9% ,转移度为 5 3 % ;直肠癌肛侧端距肿瘤 2cm以内转移率为 4 % ,2～4cm未见转移 ,低位直肠癌侧方淋巴结转移较高。结论　进展期结直肠癌有向肠管纵轴和中枢方向转移 ,并且低分化癌、浸润深度超过pT2 者淋巴转移相应增多 ,跳跃式转移是一特点 ,宜行D3式廓清术。直肠癌力争加行侧方 +全直肠系膜淋巴结清扫术 ,行低位直肠癌前切除保肛手术 ,切断距肿瘤下缘 2～ 3cm吻合口处不易残留癌组织。Objective To investigate the rule of lymphatic metastasis in advanced colorectal cancer for a better result of radical resection.Methods Six hundred and twenty three lymph nodes from 74 cases of colorectal cancer undergoing D 3 resection were analyzed and classified as peritumor, longitudinal spread, and upward spread groups.Results the metastatic rate of the patients and the incidence of positive lymph node in the peritumor, longitudinal spread as well as upward spread (N 2 and N 3) was 47% and 38 6%, 23% and 18 6% as well as 29% (20% and 9%) and 10 2% (19 0% and 5 3%), respectively. The distribution rate of metastatic lymph node was 61 2%, 17 1% and 21 6% in the longitudinal spread and upward spread, respectively.The metastatic rate was 4% within 2 0 cm on the anal side of rectal cancer. While no metastasis was found beyond 2 cm. Cancer situated at the lower part of the rectum had higher lateral metastatic rate.Conclusions Colorectal cancer tended to metastasize to longitudinal and upward lymph nodes, and metastasis risk increased in case of pT 3 and pT 4 stage as well as in low differentiation cancer. Jump metastasis is also a feature. D 3 radical resection was necessary for colorectal cancer, extended lateral lymphadenectomy and total mesorectal excision(TME) were also recommended for rectal cancer. There was no residual tumor tissue in the anastomosis after low anterior resection (LAR) when the excision distance was more than 3 cm from the anal margin of rectal cancer.

关 键 词：淋巴转移 淋巴廓清术 大肠肿瘤 

分 类 号：R735.34[医药卫生—肿瘤]