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目的 探讨中下段直肠癌侧方淋巴结转移规律及影响因素。方法 对 1995～ 2 0 0 0年行侧方淋巴结清扫的 10 5例直肠癌病人进行回顾性分析。结果 中下段直肠癌侧方转移率为 2 1% ,肿瘤的大小、部位、病理分型、分化程度及浸润深度是影响侧方转移的重要因素。在侧方淋巴结转移阳性病人中 ,单纯闭孔及髂内淋巴结转移阳性病人占 5 4 5 % ,单纯髂外及髂总淋巴结转移阳性病人为 18 1%。侧方淋巴结转移阴性病人术后局部复发率为 6 7% ,阳性病人为 36 3%。行侧方清扫局部复发率较传统术式由 17 6 %降至 11 4%。侧方转移阴性病人平均生存期为 88个月 ,阳性病人为 37个月 ,二者差异有显著性。结论 侧方淋巴转移是中下段直肠癌淋巴转移的重要途径。闭孔和髂内淋巴结是侧方淋巴结清扫中需要着重清扫的部位。侧方淋巴清扫较传统术式可明显降低局部复发率。
Objective To investigate the regularity and influencing factors of lateral lymph node metastasis in rectal cancer. Methods A retrospective analysis was performed on 105 patients with rectal cancer who underwent lateral lymph node dissection between 1995 and 2000. Results The rate of lateral metastasis in lower and middle rectal cancer was 21%. The size, location, pathological type, differentiation and infiltration depth of tumor were the important factors affecting lateral metastasis. Among the positive patients with lateral lymph node metastases, 54.5% of the patients with simple obturator and internal iliac lymph node metastasis, 18.1% of patients with simple external iliac and common iliac lymph node metastasis. The rate of local recurrence was 67% in patients with negative lymph node metastases and 36 3% in patients with positive lymph nodes. The local recurrence rate of lateral side-scan decreased from 17 6% to 114%. The average survival time of patients with lateral metastasis was 88 months and that of positive patients was 37 months, the difference was significant. Conclusions Lateral lymphatic metastasis is an important pathway for lymph node metastasis in rectal cancer. Closed-hole and internal iliac lymph nodes is the need for intensive side-stage lymph node dissection. Lateral lymphadenectomy can significantly reduce the local recurrence rate compared with traditional surgery.