直肠癌系膜淋巴结转移的临床病理学研究

目的探讨直肠癌系膜淋巴结转移的规律。方法 2 6例患者取淋巴结 4 4 3枚 ,应用淋巴结显示液处理全直肠系膜切除的直肠癌标本 ,对切取的淋巴结进行病理检测。结果 2 3例(88 5 % )患者的 1 2 8枚 (2 8 9% )淋巴结发现肿瘤转移 ,淋巴结直径≤ 0 5cm者 76枚 (5 9% )。转移病例中 ,后壁直肠癌 1 4例 ,71枚淋巴结有肿瘤转移 ,6 8枚分布于直肠上动脉旁。侧壁直肠癌 9例 ,5 7枚淋巴结有肿瘤转移 ,其中同侧直肠上动脉分支旁转移 2 9枚 ,对侧 7枚 ,同侧直肠中动脉旁转移4枚、对侧无转移。结论后壁直肠癌转移主要为上行扩散 ,侧壁直肠癌可伴有侧方淋巴结受累 ,并以肿瘤同侧淋巴结转移为主

Clinicopathological study on lymph node metastases in the mesorectum of rectal cancer

Objective To investigate the patterns of mesorectum lymph node (LN) metastases of rectal cancer. Methods Rectal cancer specimens obtained by total mesorectum excision were treated with lymph node revealing solution to retrieve all the nodes, and examined by routine pathology and immunohistochemical staining. Results A total of 443 LN in 26 specimens were harvested, with 128 nodes(28 9%)in 23 cases (88 5%) found positive. Positive nodes with the size less than 5 mm accounted for 59%. Among the 23 metastatic cases, there were 14 cases with tumors locating in the posterior wall, 69 out of 71 positive nodes were found along the superior rectal artery. In the other 9 cases, tumors were found in the lateral wall, 29 out of 57 positive nodes were found around ipsilateral branches of superior rectal artery,7 were around the contralateral branches, 4 were around the ipsilateral branches of middle rectal artery. Conclusions Most positive LN were less than 0 5 cm in diameter. LN metastasis of rectal cancer have close relationship with tumor location. Tumors in the posterior wall tend to spread upward along the superior rectal artery, while tumors in the lateral wall may have upward and lateral LN metastases simultaneously, with most metastatic LN found ipsilaterally.