中低位直肠癌术前放化疗后淋巴结及病理的变化  

Significant lymphnode and pathological responses after neoadjuvant radiochemotherapy for middle and low rectal cancer

作　　者：余阳[1] 许涛[1] 方军[1] 张应天[1] 

机构地区：[1]江汉大学附属医院普外科,武汉430015

出　　处：《腹部外科》2014年第4期279-283,共5页Journal of Abdominal Surgery

摘　　要：目的探讨中低位直肠癌放化疗后淋巴结数目的变化及病理学的特点。方法回顾性分析2003年2月至2011年6月收治的局部进展期直肠癌共75例，放化疗后6～8周后接受开腹手术的并发症、淋巴结数目的变化及应用Mandard分级评价其病理学变化及预后。结果本组所有病例皆为R0切除。其中，54例接受经腹直肠癌切除术（Dixon术）、21例接受经腹会阴联合直肠癌根治术（Miles术），发生2例吻合口漏。共获得1850枚淋巴结，每例平均（24．7±8．2）枚。其中，29例患者确定为pN＋，阳性淋巴结数目共计140枚。全组病例中病理学完全缓解者共计11例（14．7％），病理学部分缓解共计46例（61．3％），而病理学无缓解18例（24％）。11例病理学完全缓解病例中5例患者发现术后肿瘤标本中有无细胞黏液池出现，其中2例表现为恶劣预后：无瘤生存时间分别为28个月及11个月，而死亡时间分别为41个月及29个月。结论中低位直肠癌放化疗后淋巴结数目减少，但仍可满足TNM分期要求。无细胞黏液池的出现可能提示预后不佳。Objective To explore the effects of radiochemotherapy on lymph node number and pathological response for local advanced rectal cancer. Methods The clinical data were collected for 75 cases of local advanced rectal cancer on initial radiochemotherapy from February 2003 to June 2011. And surgery was performed 6 to 8 weeks later. The complications, lymph node number and pathologi- cal responses were analyzed. Results All cases underwent R0 resection. The procedures included transabdominal （n = 54） and abdominoperineal （n = 21） resections. Stoma leakage was observed in 2 cases. And 1850 lymph nodes were harvested and the average number was 24. 7 ± 8. 2 per case. pN ＋ was identified in 29 cases and the total number of positive lymph node was 140. The pathological complete, partially pathological complete and pathological poor responses were 11 （14. 7%）, 46 （61.3%） and 18 （24%） respectively. Acellular mucin pools were observed in 5/11 cases of pathological com- plete response. And poor prognosis was shown in 2 cases. Conclusions Preoperative radiochemothera- py leads to the decreased number of lymph node. However, this alteration had no effect on TNM stag- ing. The presence of acellular mucin pools in tumor samples may be a signal of poor prognosis.

关 键 词：直肠肿瘤 药物疗法 联合 淋巴结 

分 类 号：R735.37[医药卫生—肿瘤]