低位直肠癌直肠系膜盆腔侧方淋巴结转移规律分析.docVIP

低位直肠癌直肠系膜、盆腔侧方淋巴结转移规律分析 低位直肠癌直肠系膜、盆腔侧方淋巴结转移规律分析 作者：于永扬 王存 周总光 王昭 郑阳春 赵高平 陈珂玲 陈代云　 作者单位：610041 成都，四川大学华西医院消化外科研究室(于永扬、王存、周总光、王昭、郑阳春、赵高平、陈珂玲)，病理科(陈代云) 【摘要】 目的 研究低位直肠癌直肠系膜、盆腔侧方淋巴结转移和微转移规律。方法 联合运用大组织切片与组织芯片技术，研究67例全直肠系膜切除(total mesorectal excision,TME)、盆腔侧方淋巴结清扫手术标本。结果 直肠系膜淋巴结癌转移30例，微转移10例，29.6%转移淋巴结位于直肠系膜外带。肿瘤远端、肿瘤旁和肿瘤近端直肠系膜内淋巴结转移的检出例数分别为4、32和19例，与肿瘤分化程度相关。9例标本存在环周切缘癌浸润(circumferential resection margin involvement,CRMI)，2例见微转移。盆腔侧方淋巴结癌转移、微转移分别为12例和10例，与肿瘤分化程度、浸润深度相关。结论 按照TME原则手术，完整切除包裹在盆腔筋膜内的直肠系膜，可提高局部肿瘤廓清率，降低CRMI发生率。低位直肠癌盆腔侧方淋巴结转移较常见，应合理制定手术范围。 【关键词】 直肠肿瘤； 淋巴结转移 Metastasis of mesorectum and lateral pelvic lymph nodes in patients with lower rectal cancer YU Yongyang*, WANG Cun, ZHOU Zongguang, WANG Zhao, ZHENG Yangchun, ZHAO Gaoping, CHEN Keling, CHEN Daiyun.*Institute of Digestive Surgery, West China Hospital, Sichuan University, Chengdu 610041, China Corresponding author: ZHOU Zongguang, Email: zhou767@163.com 【Abstract】 Objective To discuss metastasis and micrometastasis of low rectal cancer mesorectum and later pelvic lymph node. Methods The specimens of total mesorectal excision (TME) and lateral pelvic lymph nodes in 67 patients with lower rectal cancer was studied by using techniques of large tissue section and tissue microarray. Results There were 30 patients with metastasis and 10 with micrometastasis of mesorectum lymph node cancer, with 29.6% of metastatic lymph node locating at outside part of the mesorectum. There found 4, 32 and 19 patients with lymph node metastasis inside mesorectum respectively at distal, lateral and proximal parts of the cancer, which was correlated with differentiation degree of the cancer. Circumferential resection margin involvement (CRMI) was found in the specimens of 9 patients and micrometastasis in those of the other 2 patients. There were 12 patients with metastasis of lateral pelvic lymph node cancer and 10 with micrometastasis, which was related to differentiation degree