直肠癌肠系膜下动脉根部淋巴结转移规律的分析

目的:通过对临床资料的总结,分析直肠癌肠系膜下动脉根部淋巴结的转移规律,并探讨肠系膜下动脉根部淋巴结清扫在直肠癌手术治疗中的意义.方法:通过复习文献对我院1995年1月至2000年3月95例行肠系膜下动脉根部淋巴结清扫的直肠癌病例进行回顾性临床分析.结果:肠系膜下动脉根部淋巴结转移率为14.7%.肿瘤位于腹膜反折以上,分化程度为低分化,病理结果为黏液腺癌或印戒细胞癌、肿瘤浸润深度达到pT3和pT4期的直肠癌病人,其肠系膜下动脉根部淋巴结转移率明显增高.肠系膜下动脉根部淋巴结转移的病人5年生存率为25.0%,而阴性者为78.6%.结论:瘤位于腹膜反折以上,低分化,术前病理结果为黏液腺癌或印戒细胞癌,浸润深度达到pT3和pT4期,是影响直肠癌肠系膜下动脉根部淋巴结转移的因素,在直肠癌根治手术中,应行肠系膜下动脉根部淋巴结清扫,以提高5年生存率.

Analysis of lymph nodes metastasis around inferior mesenteric artery in rectal cancer

SUMMARY Objective: To analysis factors affecting the metastasis of lymph nodes around the inferior mesenteric artery in rectal cancer, and the significance of root nodes lymphadenectomy in radical surgery for rectal cancer. Methods: Ninety five patients with rectal cancer underwent radical surgery and lymphadenectomy of root nodes of mesenteric artery in our hospital from January 1995 to March 2000 was studied. Their clinical data were reviewed retrospectively. Results: The rate of lymph nodes metastasis around the origin of inferior mesenteric artery was 14.7%. Inferior mesenteric artery root nodal metastasis occurred more frequently with tumor located upon the peritoneal reflection, low differentiation, mucous adenocarcinoma or signet ring cell carcinoma, pT 3 and pT 4 tumor. The five year survival rate in patients with inferior mesenteric artery root nodal metastasis was 25.0%, which rate was significantly lower than those without metastasis(78.6%). Conclusion: In radical surgery of rectal cancer, lymphadenectomy of root nodes around inferior mesenteric artery should be performed for the following risk factors:patients with tumor upon the peritoneal reflection, low differentiation, mucous adenocarcinoma or signet ring cell carcinoma, pT 3 and pT 4 tumor.