低位直肠癌淋巴结转移的分析

目的:探讨腹膜返折以下直肠癌淋巴结转移的规律及其临床价值.方法:对行侧方淋巴结清扫的182例低位直肠癌病人进行回顾性分析.结果:腹膜返折以下直肠癌存在侧方淋巴结转移,转移率为16%,低分化腺癌及粘液腺癌侧方淋巴结转移率高.结论:侧方淋巴结转移是腹膜返折以下直肠癌淋巴转移的重要途径,低位进展期直肠癌应在上方淋巴结清扫的同时行侧方淋巴结清扫.     

低位直肠癌侧方淋巴结清扫56例临床分析

目的探讨侧方淋巴结清扫在直肠癌根治术中的临床意义。方法对56例低位直肠癌患者行根治术,清除上方3组淋巴结的同时行侧方淋巴结清扫,对淋巴结的转移情况、并发症、局部复发率、生存率进行分析。结果56例中30例有淋巴结转移,其中侧方淋巴结转移9例,占阳性淋巴结病例的30.0%,占全部病例的16.7%。3年局部复发3例（5.4%）,3年生存率89.3%。结论为保证根治手术的彻底性,减少肿瘤复发,对腹膜返折部以下的低位直肠癌除上方淋巴结必须清扫达第3站外,有必要同时进行侧方淋巴结清扫。神经损伤是侧方淋巴结清扫的主要并发症。     

直肠癌扩大根治术中几个原则问题的探讨

目的探讨在低位直肠癌治疗中直肠系膜全切除(TME)原则和侧方淋巴结清扫的意义.方法回顾分析哈尔滨医科大学附属肿瘤医院1981年9月～1995年10月782例经扩大根治术的大肠癌病人的资料.术中遵循TME原则及扩大淋巴结清除的方法清除直肠癌上方、侧方及部分下方淋巴结.应用常规病理学的方法观察其侧方淋巴转移的规律并以直接方法统计侧方转移阳性病例的生存率.结果(1)侧方淋巴转移是腹膜返折以下直肠癌的转移途径,约占该部位直肠癌的12.5%;(2)侧方淋巴转移易发生在低分化腺癌及粘液腺癌.肉眼类型中的有浸润倾向者,侧方淋巴转移与浸润深度有关;(3)侧方转移者的五年生存率为42.2%.结论腹膜返折以下的进展期直肠癌应该在TME的同时行侧方淋巴清除,如此可以避免转移淋巴结及系膜组织的残留,提高生存率.     

直肠癌侧方淋巴结转移及其清除的意义

目的：总结直肠癌病人侧方淋巴结转移率，方法：分析我院５４３例进展期直肠癌施行扩大根治术的结果。结果：直肠癌侧方转移率为９．６％，主要发生于腹膜返折以下的癌，多见于分比较差的低分化腺癌及粘液腺癌，结论：对于腹膜返折以下的进展期直肠癌必须进行侧方消除，尤其分化差者，可以提高生存率。     

直肠癌侧方淋巴结转移及其清除的意义

目的：总结直肠癌病人侧方淋巴结转移率。方法：分析我院543例进展期直肠癌施行扩大根治术的结果。结果；直肠癌侧方转移率为9．6％，主要发生于腹膜退折以下的癌，多见于分化较差的低分化腺癌及粘液腺癌。结论：对于腹膜返折以下的进展期直肠癌必须进行侧方清除，尤其分化差者．可以提高生存率。     

直肠不同部位进展期癌的手术原则和方法

目的:探讨直肠不同部位进展期癌患者的手术原则、手术方法及其临床意义.方法:回顾性分析96例进展期直肠癌患者的临床资料.结果:肿瘤位于腹膜返折以下者41例行全直肠系膜切除术(TME),位于腹膜返折以上者55例行宽直肠系膜切除术(WME),两组疗效相仿.行前切除术(AR)75例,腹会阴联合切除术(APR)21例,AR组与APR组术后2、3年局部复发率和3、5年生存率均无显著差别.96例行肠系膜下动脉根部结扎并清扫该动脉根部及腹主动脉前区域淋巴结(D3),肠系膜下动脉根部淋巴结(N3)转移率11.5%,N3转移阳性组和阴性组术后疗效无显著差别.行闭孔及髂内淋巴结清扫11例,2例转移.结论:上中段直肠癌只须行WME,下段直肠癌应行TME;保肛手术要以根治为前提,不可盲目追求保肛率的高低;各部位进展期直肠癌患者均应行D3式扩大淋巴结清扫,部分下段直肠癌患者应同时行侧方淋巴结清扫.     

低位直肠癌侧方淋巴结转移的影响因素

目的 分析低位直肠癌侧方淋巴结转移相关临床病理因素.方法 采用单因素和logistic多因素回归分析方法,分析低位直肠癌侧方淋巴结转移与其临床病理因素的关系.结果 患者性别、年龄、肿瘤位置、肿瘤占肠腔周径、Ki-67表达与侧方淋巴结转移无明显相关性,而肿瘤浸润深度、肿瘤直径、血清CEA含量、E-cad表达与侧方淋巴结转移相关.其影响作用大小的顺序为:浸润深度>血清CEA浓度>肿瘤最大直径>E-cad表达.结论 直肠癌侧方淋巴结转移率较低,不推荐常规行侧方淋巴结清扫;肿瘤浸润深度、肿瘤直径、血清CEA含量、E-cad表达是影响低位直肠癌侧方淋巴结转移的因素,对临床上手术方式的制定有一定参考价值.     

国外低位直肠癌侧方转移淋巴结的清扫

目前国外对腹膜反折下低位进展期直肠癌的外科治疗研究集中在手术方式的合理选择、切除肿瘤远端肠管范围和保留肛门括约肌手术。有关清扫区域淋巴结转移范围 ,特别是侧方（平行）淋巴结转移的清扫不断增加。为了深入了解对局部复发率高的低位直肠癌术后复发的控制程度及提高５年生存率 ,本文对国外的有关进展作一概述。１直肠癌侧方淋巴结的转移率腹膜反折下（Ｒｂ）直肠的淋巴引流 ,虽主要向上方但也向下方和两侧髂内血管淋巴结输出 ,因而直肠癌发生部位的划分 ,应以腹膜反折为界（距肛缘约７ｃｍ左右）较为合理、实用。从局部解剖学角度而…     

侧方淋巴结清扫在低位直肠癌治疗中的临床意义

外科手术仍是治疗直肠癌最主要的手段.直肠癌根治术的失败原因多为血道播散、淋巴转移和局部复发,这些因素都是危及直肠癌患者术后生活质量的问题.我院自1997年起开始对低位直肠癌淋巴结转移规律进行研究,现就侧方淋巴结清扫(侧方清扫)在低位直肠癌治疗的临床意义加以总结.     

直肠癌行侧方淋巴结清扫52例临床分析

目的探讨中下段直肠癌的侧方淋巴结转移情况。方法对1996年6月至2004年8月间行传统直肠癌根治术加盆腔侧方淋巴结清扫术的52例中下段直肠癌的临床资料进行回顾性分析。结果全组侧方淋巴结转移率9.62%(5/52)。有侧方淋巴结转移者多为浸润型和溃疡型,肿瘤较大占1/2肠周以上(直径>4 cm),肿瘤浸润全层并有局部外侵,分化差的低分化及黏液腺癌及年龄<50岁。结论应有选择性地对溃疡型或浸润型、肿瘤较大及分化差的中下段直肠癌患者行侧方淋巴结清扫术。     

Extent of lymph node dissection in rectal carcinoma

Basing on 170 specimens of advanced rectal cancers radically resected, metastatic rule and extent of lymph node dissection were studied in order to guide future surgical treatment. In 170 cases, 77 had lymph node metastases. The lymph node metastatic rate was 45.3% and metastatic degree was 8.9% (527/5 912). Metastasis of the rectal cancer, according to the lymphatic anatomy, can be divided into upward, lateral and downward drain. Because the rectal cancer at any site can lead to the upward metastasis, the upward lymph node dissection, up to the base of inferior mesenteric artery (the third line of lymph nodes), must be done in all rectal cases, otherwise, 10% of patients would have residual cancer. In view of the lateral metastasis occurring only in rectal cancers under the peritoneal reflection, for which lateral lymph node dissection is necessary or one eighth of patients would have residual lesion. Generally, no lateral lymph node dissection is needed in cancers above the peritoneal reflection. Pathologic factor influencing the lymphatic metastasis is the form of tumor growth, such as poorly differentiated and mucoid adenocarcinomas aggressively growing deeply and extensively resulting in a higher lymph node metastatic rate, for which lymph node dissection must be performed.     

甲状腺癌颈部淋巴结转移区域的超声特点研究

目的：探究甲状腺癌颈部淋巴结转移区域的超声特点。方法回顾性分析58例甲状腺癌患者的临床资料。将患者术前颈部淋巴结转移区域的超声诊断与患者的病理诊断进行比较,分析其超声表现的特点。结果58例患者中经术前超声诊断显示,有36例（62．07％）颈部淋巴结转移,其中3例单纯中央区淋巴结转移、18例单纯颈侧区淋巴结转移、15例颈侧区合并中央区淋巴结转移;中央区淋巴结转移率为31．03％,显著低于颈侧区淋巴结转移率56．89％。病理诊断结果显示,58例患者中有33例（56．89％）颈部淋巴结转移,其中21例单纯中央区淋巴结转移,2例单纯颈侧区淋巴结转移,10例颈侧区合并中央区淋巴结转移;中央区淋巴结转移率为53．44％,显著高于颈侧区淋巴结转移率20．68％。超声诊断颈部转移性淋巴结的特异性为80．0％（12／15）,敏感性为100．0％（33／33）。超声检查对中央区转移性淋巴结的检出率为58．06％（18／31）,显著低于颈侧区转移性淋巴结的检出率100．0％（12／12）。超声诊断颈侧区淋巴结转移与病理结果的符合率为36．36％（12／33）,显著低于中央区淋巴结转移与病理结果的符合率58．06％（18／31）,差异具有统计学意义（P＜0．05）。颈侧区和中央区中淋巴门回声消失和低回声占较高的比例,且颈侧区和中央区颈侧区转移性淋巴结中L／T＜2所占的比例差异具有统计学意义（P＜0．05）。结论甲状腺癌多转移至颈部中央区淋巴结,采用超声检查具有较高的特异性,对中央区淋巴结的诊断有十分重要的意义。     

MEK1在结直肠癌中表达及临床意义的研究

Objective: The aim of this study was to investigate the relationship between expression of MEK1 protein in the mitogen-activated protein kinase (MAPK) signaling pathway and liver as well as lymph node metastasis in colorectal cancer patients.Methods: Immunohistochemistry was performed to detect the expression of MEK1 protein in primary cancer, normal colonic mucosa, lymph nodes and liver metastatic foci from 86 colorectal cancer patients.Life table analysis was employed to evaluate the association between MEK1 expression and patients' survival.Results: The positive rate of MEK1 expression in the primary cancer, normal colonic mucosa, metastatic lymph nodes and liver metastatic foci was 52.3%, 32.6%, 71.4% and 78.3%, respectively.The positive rate of MEK1 expression in the primary cancer, metastatic lymph nodes and liver metastatic foci was significantly higher than that in the normal colonic mucosa (P < 0.01).Furthermore, the positive rate of MEK1 expression in stage III and IV colorectal cancer patients was dramatically higher than that in stage I and II colorectal cancer patients (P < 0.01).The positive rate of MEK1 expression in patients with poorly differentiated adenocarcinoma and mucinous adenocarcinoma was significantly higher than patients with well or moderately differentiated adenocarcinoma (P < 0.01).The 3-year disease-free survival rate was 41.3% in MEK1 positive patients and 73.1% in MEK1 negative patients.The survival rate of MEK1 positive patients was significantly lower than that of MEK1 negative patients (P < 0.05).Conclusion: The increased expression of MEK1 was associated with lymph node metastasis and liver metastasis of colorectal cancer.Therefore, detection of MEK1 expression may have important significance in the evaluation of patients' prognosis.     

What Is the Role of Lateral Lymph Node Excision in Patients with Locally Advanced Rectal Cancer Who Received Preoperative Chemoradiotherapy?

In the era of preoperative chemoradiotherapy (CRT) for rectal cancer, the role of lateral pelvic lymph node dissection (LPLND) has become much more complicated because preoperative CRT affects both the lateral pelvic lymph nodes (LPLN) and the main tumor. Most previous studies do not demonstrate the benefits of LPLND following preoperative CRT in comparison with total mesorectal excision, although some authors have argued that selective LPLND is beneficial. LPLN treatment strategies differ depending on whether the disease was considered systemic metastatic disease or local disease which can be treated using surgical resection. The role of LPLND in rectal cancer is better evaluated on the basis of its oncologic impact rather than technical feasibility. Here, we review LPLN metastasis status in rectal cancer, whether LPLN metastasis is systemic or local disease, and studies on the use of LPLND to treat rectal cancer.     

直肠癌术前淋巴结转移的影像学研究进展

直肠癌是最常见的癌症之一,严重危害人类健康。术前新辅助放化疗已经广泛应用于直肠癌患者,其治疗决策在很大程度上取决于患者是否存在淋巴结转移,这就为淋巴结的术前诊断提出了很大的挑战。目前,评估淋巴结状态通常采用影像学方法,传统CT、MRI及PET/CT对转移淋巴结的诊断效能并不理想,近年来,随着双能CT及动态对比增强磁共振等新的影像学技术的发展,为术前诊断淋巴结转移提供了新的可供选择的方法,越来越多的研究显示,这些新技术对于直肠癌转移淋巴结的诊断准确性已经明显超过了传统的影像学方法。本文将介绍近年来新的影像学诊断方法对于直肠癌转移淋巴结的诊断价值。     

Rectal cancer with jumping metastasis to the obturator lymph node only

In May, 1993, we operated upon a 40-year-old woman with lower rectal cancer with jumping metastasis to a solitary right obturator lymph node only. For the rectal cancer with submucosal invasion, we performed low anterior resection with regional lymph node dissection as far as the second group, based on theGeneral rules for clinical and pathological studies on cancer of colon, rectum and anus, 4th edition, of the Japanese Society for Cancer of the Colon and Rectum, including the obturator lymph nodes. Well differentiated adenocarcinoma and mucinous carcinoma were seen in the submucosal invasive front. The risk of obturator metastasis must be considered during operation for rectal cancer.     

cN0声门上型喉癌的颈部复发相关因素分析

背景与目的：声门上型喉癌的隐性淋巴结转移率高,是此类喉癌诊治的重点之一。本研究旨在探讨声门上型喉癌的隐性淋巴结转移的相关因素、预后及治疗情况。方法：回顾分析1992-1999年我科收治的oNO声门上型喉癌104例。对其隐性淋巴结转移率、转移淋巴结的分布、影响隐性淋巴结转移的因素及颈部处理等进行研究。结果：本组cNO声门上型喉癌隐性淋巴结转移率为23．1％（24／104）,其中T2期23．9％（11／46）,T3期30．8％（8／26）,T4期18．5％（5／17）。隐性转移淋巴结主要位于病变侧Ⅱ、Ⅲ区（22／24）。出现隐性转移组预后差（log-rank=10．66．P=0．001）。切缘阳性影响隐性淋巴结转移率（χ^2=10．015,P=-0．002）。病理分化程度（χ^2=3．349,P=0．175）、T分期（χ^2=2．701,P=0．440）、原发灶处理方式（χ^2=1．093,P=0．296）等对隐性淋巴结转移率影响差异无统计学意义。颈部选择性清扫能降低cNO声门上型喉癌隐性淋巴结转移率（χ^2=4．070,P=0．044）。结论：cNO声门上型喉癌的隐性淋巴结转移主要位于病变侧Ⅱ、Ⅲ区;出现隐性淋巴结转移影响预后：切缘阳性影响隐性淋巴结转移率;对T1N0期喉癌颈部可观察,T2-4N0期喉癌行侧颈清扫（Ⅱ-Ⅳ区）是合理有效的。     

A case of rectal cancer with solitary adrenal metastasis

This is the case of a 67-year-old woman with a sudden on-set of lower abdominal pain and pre-shock. A physical examination showed signs of pan-peritonitis. Emergency was operation performed 5 hours after the onset. She had undergone Hartmann's operation for rectal cancer. Six month after the operation, abdominal CT scan revealed the mass of puriform acites, about 20 mm in diameter, in the right suprarenal region. Right adrenalectomy was performed with a diagnosis of solitary adrenal metastasis from rectal cancer. Histologically, the metastatic adenocarcinoma was moderately differentiated to the adrenal medulla. The capsule was kept intact, and no swelled lymph nodes were found around the adrenal gland. There have been no signs of recurrence for 4 years after the operation.     

肺癌纵隔淋巴结转移的临床病理探讨

目的 从病理学角度探索肺癌纵隔淋巴结（Ｎ２）转移的特点。方法 为３９８例肺癌患者施行根除性肺陈除淋巴结廓清术,对其中１６０例Ｎ２肺癌的３５２组纵隔转移淋巴结进行病理学研究。结果 肺癌Ｎ２转移可呈现单组、多组和跳跃式转移,分别占４１．２％、５８．８％和２９．３％。Ｎ２转移分布最密集的部位是第７组淋巴结,占４８．８％,其次是第４、３、５组淋巴结,分别占４５．６％,３１．３％和２５．６％;而且Ｎ２转移分