右半結腸癌外科干淋巴结规律及对临床预后的影响.docVIP

右半结肠癌外科干淋巴结转移规律及清扫对临床预后的影响 【摘要】目的 分析右半结肠癌外科干淋巴结转移规律，评价该区域淋巴结清扫对临床预后的影响。方法 收集本院1998年1月至2008年1月行根治性切除183例右半结肠癌患者的临床病理资料，按日本结直肠癌临床病理规约对淋巴结进行分组、分站，评价分析淋巴结转移与患者的预后情况。结果 183例患者有淋巴结转移者有91例，转移率49.7%，共捡取淋巴结2665个(包括689个外科干淋巴结)，其中转移淋巴结429个，转移度16.1%；外科干淋巴结转移者40例。外科干淋巴结转移率和转移度分别为：T1 0、T2 19.4%、T3 20.3%、T4 41.9%和T1 0、T2 13.0%、T3 13.7%、T4 24.2%，外科干淋巴结转移数目2个以下及3个以上者平均生存期、中位生存及生存率比较，差异有统计学意义（p0.05）。结论 淋巴结的转移率随肿瘤浸润深度增加而增加， T4期肿瘤患者有较高的外科干淋巴结转移率，对低分化癌、肿瘤浸润超过T4者主张把D3式淋巴结廓清术作为标准术式。 【关键词】 结肠肿瘤 淋巴结清扫 治疗效果 Principle of lymph node metastasis and effect of surgical trunk lymph nodes excision on prognosis in right hemicolonic carcinoma 【Abstract】 Objective To investigate the principle of lymph metastasis and evaluate the effect of surgical trunk lymph nodes excision on the clinical prognosis in right hemicolonic carcinoma. Methods Pathological data of 183 patients with right hemicolonic carcinoma were analyzed. The lymph nodes were classified by Japanese Clinical Pathological Rules of colon cancer. The clinicopathological characteristics and clinical prognosis were analysised. Results Metastatic lymph nodes were found in 91 patients among 183 patients with colon carcinoma. The metastatic rate was 49.7%,In a tatol retrieved and examined 2665 lymph nodes（689 surgical trunk lymph nodes were included）, 429 lymph nodes(16.1%) showed metastasis. surgical trunk lymph nodes showed metastasis in 19 patients.The metastatic rate、incidence of surgical trunk lymph nodes was 0、15.3%、30.1% 、41.2% and 0、14.3%、22.4%、50.5% in T1 T2 T3 T4 stage tumors respectively. The 5-year survival rate of patients with surical trunk lymph nodes(+) less than 2 was much higher than that of patients with surical trunk lymph nodes(+) more than 3 (p0.05). Conclusions As the depth of tumor invasion is increased, the metastatic rate of lymph nodes are markedly increased. A high rate of metastasis has been demonstrated in surgical trunk lymph nodes in T4 stage of right hemicolonic carcinoma.D3 radical resection should be pe