右半结肠癌淋巴结跳跃转移高危因素单中心前瞻性观察性研究  

High risk factors of lymphatic metastasis pattern of right colon neoplasms:a single-center prospective observational study

作　　者：崔艳成[1] 高志冬[1] 韩龙[1] 刘凡[1] 申占龙[1] 杨晓东[1] 尹慕军[1] 姜可伟[1] 梁斌[1] 沈凯[1] 叶颖江[1] 王杉[1] 

机构地区：[1]北京大学人民医院胃肠外科,北京100044

出　　处：《中国实用外科杂志》2015年第6期659-663,共5页Chinese Journal of Practical Surgery

基　　金：高等学校博士学科点专项新教师科研基金(No.20130001120064);北京大学人民医院研究与发展基金(No.RDC2013-18)

摘　　要：目的探讨右半结肠癌淋巴结转移规律。方法前瞻性入组2012年10月至2014年12月在北京大学人民医院行完整结肠系膜切除（CME）的病人，按照日本《大肠癌诊疗规范》（第7版）进行淋巴结分站取材和病理学检查，分析阳性淋巴结分布规律、影响淋巴结转移的临床病理因素。结果右半结肠癌肠旁、中间、中央淋巴结转移发生率分别33．0％、18．3％、16．5％（P=0．005），肠旁淋巴结转移主要位于距离肿瘤〈10cm以内组织，但是〉10cm组织（1．7％）仍有淋巴结转移。淋巴结转移发生率与肿瘤T分期和分化程度有关。T3～T4期病人淋巴结转移发生率，高于T1。T2期（46．2％vs．9．1％，P〈0．05）。低分化及未分化癌淋巴结转移发生率为64．7％，明显高于高分化癌（0）、中分化癌（36．0％），P〈0．05，且分化程度越差更易出现肠旁及中央淋巴结转移。幽门下组淋巴结转移发生率为2．6％（3／115），且均为结肠肝曲癌。14．8％（17／115）的病人出现跳跃性淋巴结转移。结论右半结肠癌淋巴结转移存在于肠旁、中间、根部系膜组织，术中应常规清扫，结肠肝曲癌还应清扫幽门下淋巴结，CME有助于彻底清扫该区域淋巴结。Objective To explore the lymphatic metastasis patterns of right colon neoplasms. Methods A total of 115 colon specimens performed complete mesocolie excision （CME） between October 2012 and December 2014 in Peking University People＇ s Hospital were dissected and classified according to the Japanese Clinical Pathological Rules after CME procedure, which provided the most lymph nodes harvest. The rule of lymph node metastasis and the association between clinicopathological factors and the distribution of metastatic lymph nodes were analyzed. Results The incidence of metastatic lymph nodes of paracolic group, intermediate group and the main group was 33.0%, 18.3%, 16.5% respectively （P=0.005）. The vast majority of positive nodes were located in bowel less than 10 cm from the lesion. However, there were also lymph nodes spread to the epieolic/paracolic tissue greater than 10 cm （1.7%）. Lymphatic metastasis was associated with T stage and differentiation degree. The incidence of metastatic lymph nodes （46.2%） in T3-T4 stage was significantly higher than that in T1-T2 stage （9.1%, P 〈 0.05）. The incidence of lymphatic metastasis in poor differentiated and undifferentiated tumor was 64.7% , higher than that in well differentiated （0） and moderate differentiated one （36.0%, P 〈 0.05） and lymphatic metastases in paracolic group and the main group were easier to be seen in poor differentiated tumor. The incidence of metastatic lymph nodes in infrapyloric region was 2.6% （3/115）. The metastasis incidence of skip lymph node was 14.8% （17/115）. Conclusion Lymph nodes could spread to epicolic/paracolic tissue, intermediate mesocolon and root of the supplying vessels, which should be dissected routinely. It is necessary to clear infrapyloric region for hepatic colon cancer. CME procedure can help to thoroughly clean the regional lymph nodes.

关 键 词：结肠肿瘤 完整结肠系膜切除 淋巴结转移 

分 类 号：R6[医药卫生—外科学]