摘要
目的研究低位直肠癌直肠系膜、盆腔侧方淋巴结转移和微转移规律。方法联合运用大组织切片与组织芯片技术,研究67例全直肠系膜切除（total mesorectal excision,TME）、盆腔侧方淋巴结清扫手术标本。结果直肠系膜淋巴结癌转移30例,微转移10例,29.6%转移淋巴结位于直肠系膜外带。肿瘤远端、肿瘤旁和肿瘤近端直肠系膜内淋巴结转移的检出例数分别为4、32和19例,与肿瘤分化程度相关。9例标本存在环周切缘癌浸润（circumferential resection margin involvement,CRMI）,2例见微转移。盆腔侧方淋巴结癌转移、微转移分别为12例和10例,与肿瘤分化程度、浸润深度相关。结论按照TME原则手术,完整切除包裹在盆腔筋膜内的直肠系膜,可提高局部肿瘤廓清率,降低CRMI发生率。低位直肠癌盆腔侧方淋巴结转移较常见,应合理制定手术范围。
Objective To discuss metastasis and micrometastasis of low rectal cancer mesorectum and later pelvic lymph node. Methods The specimens of total mesorectal excision （TME） and lateral pelvic lymph nodes in 67 patients with lower rectal cancer was studied by using techniques of large tissue section and tissue microarray. Results There were 30 patients with metastasis and 10 with micrometastasis of mesorectum lymph node cancer, with 29.6% of metastatic lymph node locating at outside part of the mesorectum. There found 4, 32 and 19 patients with lymph node metastasis inside mesorectum respectively at distal, lateral and proximal parts of the cancer, which was correlated with differentiation degree of the cancer. Circumferential resection margin involvement （CRMI） was found in the specimens of 9 patients and micrometastasis in those of the other 2 patients. There were 12 patients with metastasis of lateral pelvic lymph node cancer and 10 with micrometastasis, which was related to differentiation degreee and infiltration depth of the cancer. Conclusions Based on TME principle, complete excision of the mesorectum wrapped inside visceral pelvic fascia is essential for increasing local clearance and decreasing incidence rate of CRMI. Metastasis of lateral pelvic lymph node in lower rectal cancer is commonly seen and should be managed with a rational range of operation.
出处
《中华消化外科杂志》
CAS
CSCD
2007年第4期303-306,共4页
Chinese Journal of Digestive Surgery
基金
本课题受中国博士后科学基金资助（No.2005038614）
关键词
直肠肿瘤
淋巴结转移
Rectal cancer
Lymph node metastasis
