Miles术直肠标本淋巴结分布及转移研究

目的 探讨超低位直肠癌淋巴结转移、微转移的规律及其对手术方式选择的价值.方法 运用大组织切片、组织芯片研究23例低位直肠癌Miles手术标本.结果 23例标本直肠系膜共检获淋巴结415枚,其中转移淋巴结169枚,微转移59枚;12例标本有淋巴结癌转移,4例为淋巴结微转移.29.0%(49/169)、17.2%(29/169)转移淋巴结分别位于直肠系膜的外带和前区;坐骨直肠窝检出转移或微转移淋巴结占总淋巴结的22%(8/36),坐骨直肠窝淋巴结转移或微转移者占13%(3/23).结论 低位直肠癌存在区域淋巴结转移,各区域受累率不一.括约肌累及、远侧直肠系膜和坐骨直肠窝内淋巴结转移和微转移率不高,Miles手术作为低位直肠癌标准术式的价值应重新评估.

Metastasis and micrometastasis in ultra-low rectal cancer

Objective To study cancer metastasis in mesorectum and ischiorectal loss in cases of ultra-low rectal cancer and evaluate the rationale of Miles procedure. Methods Whole-mount slice and tissue mieroarray technique were used to study the dissected specimen from 23 cases of uhra-low rectal cancer for metastatic lymph nodes. Result 415 lymph nodes were harvested in 23 mesorectum specimen, 169 and 59 lymph nodes were metastasic and micrometastasie respectively. 12 eases were diagnosed with metastasis, 4 cases were found to have micrometastasis. Metastatic lymph nodes in the lateral and anterior mesorectum were 29.0% (49/169) and 17.2% (29/169) respectively. There were 2 patients with metastasis and 1 with micrometsstssis in ischiorectal fossa lymph nodes, accounting for 13% patients. Conclusion Regional metastasis exists in ultra-low rectal cancer and its incidence varies in different location of mesorectum and ischiorectal fessa. The value of Miles procedure as the standard therapy for ultra-low rectal cancer should undergo an evaluation.