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目的 探讨中下段直肠癌侧方淋巴结转移规律及影响因素。方法 对1995－2000年行侧方淋巴结清扫的105例直肠癌病人进行回顾性分析。结果 中下段直肠癌侧方转移率为21％，肿瘤的大小、部位、病理分型、分化程度及浸润深度是影响侧方转移的重要因素。在侧方淋巴结转移阳性病人中，单纯闭孔及髂内淋巴结转移阳性病人占54．5％，单纯髂外及髂总淋巴结转移阳性病人为18．1％。侧方淋巴结转移阴性病人术后局部复发率为6．7％，阳性病人为36．3％。行侧方清扫局部复发率较传统术式由17．6％降至11．4％。侧方转移阴性病人平均生存期为88个月，阳性病人为37个月，二者差异有显著性。结论 侧方淋巴转移是中下段直肠癌淋巴转移的重要途径。闭孔和髂内淋巴结是侧方淋巴结清扫中需要着重清扫的部位。侧方淋巴清扫较传统术式可明显降低局部复发率。

The study of lateral lymphadenectomy for rectal cancer in 105 patients.

Objective To study the pattern of lateral lymph node metastasis for middle or lower rectal cancer and discuss its influent factor. Methods 105 patients with middle or lower rectal cancer who underwent pelvic lymphadenectomy from 1995 to 2000 were reviewed. Results The overall metastatic rate of lateral lymph node is 21%.Tumor size,level of the tumor,pathologic classification,differentiation and depth of the invasion affect lymph nodes metastasis significantly.Among 22 patients with lateral lymph node involvement, the rate of simple obturator and internal iliac lymph nodes metastasis is 54 5%;The rate of simple external iliac and common iliac lymph nodes metastasis is 18 1%. The incidence of local recurrence for patients with negative lymph node is 6 7% and with positive one is 36 3%. Pelvic lymphadenectomy can decrease local recurrence from 17 6% to 11 4%. Negative involvement indicates a high average survival time of 88 months in contrast with 37 months of positive involvement. Conclusion Lateral lymph nodes metastasis is an important way for middle or lower rectal cancer. Internal and obturater lymph node dissection is necessary when applying pelvic lymphadenectomy. Pelvic lymphadenectomy can decrease local recurrence obviously in comparison with conventional dissection.