结肠肝曲癌淋巴结转移规律及影响因素的前瞻性临床分析  

Prospective Clinical Analysis of Lymph Node Metastasis and Influencing Factors in Hepatic Flexure Colon Carcinoma

作　　者：李明 杨庆强 LI Ming;YANG Qingqiang(Department of the General Surgery,The Affiliated Hospital of Southwest Medical University,Sichuan 646000,China)

机构地区：[1]西南医科大学附属医院胃肠外科,泸州646000

出　　处：《医学研究杂志》2022年第10期147-150,142,共5页Journal of Medical Research

摘　　要：目的探讨结肠肝曲癌淋巴结转移规律及其影响因素。方法前瞻性入组2019年7月~2021年8月在西南医科大学附属医院确诊为结肠肝曲癌并接受右半结肠癌根治术的患者65例,术后进行淋巴结分站取材,分析淋巴结转移规律及其影响因素。结果65例结肠肝曲癌患者淋巴结转移率为52.3%(34/65),肠旁淋巴结、中间淋巴结、中央淋巴结转移率分别为43.1%、13.8%、20.0%(χ^(2)=16.192,P<0.001),淋巴结转移与肿瘤分化程度、T分期有关。分化程度越差,淋巴结转移率越高(P<0.05),且分化程度越差越容易出现中央淋巴结转移。T_(3)~T_(4)期患者淋巴结转移率高于T_(1)~T_(2)期(56.7%vs 0,P<0.05),且T_(4)期患者相比于T_(1)~T_(3)期更容易出现肠旁淋巴结转移。21.5%(14/65)的患者出现了跳跃性淋巴结转移,其中最常见的模式为肠旁(+)中间(-)中央(+)。所有患者均未见幽门下淋巴结(No.206)转移。结论结肠肝曲癌淋巴结转移主要存在于肠旁、中间、根部系膜组织中,且存在跳跃性淋巴结转移现象,建议行D_(3)根治术或CME以保证R0切除。幽门下淋巴结无需常规清扫,但若术前或术中怀疑有转移,则应予以清扫。肿瘤分化程度及T分期是影响淋巴结转移的独立危险因素。Objective To investigate the regularity of lymph node metastasis and its influencing factors in hepatic flexure carcinoma.Methods From July 2019 to August 2021,65 patients with hepatic flexure cancer and underwent radical resection of right-side colon cancer in the Affiliated Hospital of Southwest Medical University were prospectively enrolled in the group.The lymph node samples were collected according to different stations.The regularity of lymph node metastasis and its influencing factors were analyzed.Results Among the 65 patients with hepatic flexure carcinoma,the rate of lymph node metastasis was 52.3%(34/65).The metastatic rates of parenteral lymph nodes,intermediate lymph nodes and central lymph nodes were 43.1%,13.8%and 20.0%,respectively(χ^(2)=16.192,P<0.001).Lymph node metastasis was related to the degree of tumor differentiation and T stage.The worse the degree of differentiation,the higher the rate of lymph node metastasis(P<0.05),and the worse the degree of differentiation,the more likely to have central lymph node metastasis.The rate of lymph node metastasis in patients with stage T_(3)-T_(4) was higher than that in stage T_(1)-T_(2)(56.7%vs 0,P<0.05),and patients with stage T_(4) were more likely to have parenteral lymph node metastasis than patients with stage T_(1)-T_(3).21.5%(14/65)of the patients had jumping lymph node metastasis,and the most common pattern of jumping metastasis was parenteral(+),intermediate(-),central(+).No subpyloric lymph node(No.206)metastasis was found in all patients.Conclusion Lymph node metastasis of hepatic flexure carcinoma mainly exists in parenteral,intermediate and root mesangial tissues,and there is a phenomenon of jumping metastasis.D_(3) radical resection or CME is recommended to ensure R0 resection.There is no need for routine dissection of subpyloric lymph nodes,but if metastasis is suspected before or during operation,it should be dissected.The degree of tumor differentiation and T stage are independent risk factors for lymph node metastasis.

关 键 词：结肠肝曲癌 淋巴结转移 影响因素 

分 类 号：R735.3[医药卫生—肿瘤]