中下段直肠癌盆腔侧方淋巴转移情况与转归

目的探讨中下段直肠癌盆腔侧方淋巴结转移(简称侧方转移)的规律和预后。方法对1990～2001年经根治性切除证实侧方转移的20例中下段直肠癌患者的临床资料进行回顾性分析。结果85.0%(17/20)的患者为直肠系膜和/或根部淋巴转移加侧方转移,15.0%(3/20)的患者为单纯侧方转移。侧方转移率依次为闭孔动脉45.0%(9/20)、髂内动脉40.0%(8/20)、髂总动脉20.0%(4/20)、髂外动脉15.0%(3/20)和腹主动脉分叉淋巴结5.0%(1/20)。75.0%的患者发生术后远处转移或远处转移合并盆腔局部复发,其中83.3%发生于术后2年内。患者平均生存期21.6个月,术后3年、5年生存率分别为16.7%和0。结论中下段直肠癌侧方转移不仅是盆腔局部病变,还可能是属于全身病变的一部分,提示直肠癌远处转移发生的可能性。

The characteristics of lateral node metastasis in middle/lower rectal cancer and its influence on the prognosis

Objective To study the pattern of lateral node metastasis in middle/lower rectal cancer and its influence on the prognosis. Methods Twenty patients with middle lower rectal cancer who had lateral node involvement received radical resection from 1990 to 2001. The patterns of lymph node metastasis and prognosis were analyzed. Results Lateral node metastasis alone was found in 3 cases (15.0%), and lateral node metastasis accompanied with upward node metastasis in 17 cases (85.0%). The incidences of obturator nodes, internal iliac nodes, common iliac nodes, external iliac nodes and aortic bifurcation nodes metastasis were 45.0%(9/20),40.0%(8/20),20.0%(4/20),15.0%(3/20)5.0%(1/20)respectively. Distant metastases or distant metastases plus pelvic recurrence occurred in 75.0%of the patients and 83.3%of such cases occurred during the first 2 years postoperatively. The mean survival time was 21.6 months. The 3 and 5 year survival rates were 16.7%and 0 respectively. Conclusions For middle/lower rectal cancer, lateral node metastasis may be not only a pelvic local disease, but also a part of systemic disease,and predict the high possibility of distant metastasis.