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目的 探讨中下段直肠癌的淋巴转移规律和淋巴清扫范围。 方法 对 1990～ 1999年行传统直肠癌根治术的 373例和行传统直肠癌根治术加盆腔侧方淋巴清扫术 (简称侧方清扫术 )的89例中下段直肠癌患者进行回顾性分析。 结果 全组淋巴转移率为 41 8% ,患者年龄、癌灶浸润深度、大体分型、癌灶大小是影响淋巴转移率的重要因素 (P <0 0 5 )。 89例侧方清扫术的盆腔侧方淋巴转移率为 15 7% ,其中 85 7%位于癌灶同侧。有盆腔侧方淋巴转移者均为浸润深度T3 、T4 者 ;癌灶>3cm、溃疡型或浸润型、年龄 <6 0岁者盆腔侧方淋巴转移率较高。侧方清扫术组的盆腔复发率为5 6 % ,明显低于传统直肠癌根治术组的 17 7% (P <0 0 5 ) ;侧方清扫术组和传统直肠癌根治术组的 5年生存率分别为 46 7%和 47 9% (P >0 0 5 )。 结论 应提高对中下段直肠癌淋巴转移规律的认识 ,对怀疑或证实有淋巴结转移、癌灶侵犯浆膜或穿透肠壁、癌灶 >3cm、溃疡型或浸润型、年龄 <6 0岁者建议行侧方清扫术
Objective To explore the lymphatic metastasis and lymphadenectomy range in the middle and lower rectal cancer. METHODS: A retrospective analysis of 373 patients undergoing radical resection of conventional rectal cancer from 1990 to 1999 and 89 patients with mid-lower rectal cancer who underwent conventional radical resection plus pelvic lateral lymph node dissection (abbreviated as lateral dissection) were retrospectively analyzed. Results The lymph node metastasis rate in the whole group was 41.8%. The age, depth of invasion, gross classification, and tumor size were important factors affecting the lymphatic metastasis rate (P < 0.05). The rate of pelvic lymph node metastasis was 89.7% in 89 cases of lateral dissection, of which 85.7% was located on the same side of the foci. Patients with pelvic lymph node metastasis were those with T3 and T4 infiltration depth; those with >3cm, ulcer or infiltration, and <60 years of age had higher pelvic lymph node metastases. The rate of pelvic recurrence in the lateral dissection group was 56 %, which was significantly lower than that of the conventional radical rectal cancer group (17%) (P <0 05); 5 years in the lateral dissection group and the conventional rectal cancer resection group. The survival rates were 46 7% and 47 9%, respectively (P > 0 05). Conclusion It is necessary to improve the understanding of the lymphatic metastasis pattern in the middle and lower rectal cancers, and to suspect or confirm the presence of lymph node metastasis, invasion of the serosal invasion of the lesions or penetrating the intestinal wall, tumors>3cm, ulcerative or infiltrative, age <60 years old Proposed lateral dissection