Dong X S, Ding L, Zhao T Z, Yan F C, Liu F S, Zhao J H
Third Hospital, Haerbin Medical College.
Zhonghua Zhong Liu Za Zhi. 1987 Jul;9(4):308-10.
Basing on 170 specimens of advanced rectal cancers radically resected, metastatic rule and extent of lymph node dissection were studied in order to guide future surgical treatment. In 170 cases, 77 had lymph node metastases. The lymph node metastatic rate was 45.3% and metastatic degree was 8.9% (527/5 912). Metastasis of the rectal cancer, according to the lymphatic anatomy, can be divided into upward, lateral and downward drain. Because the rectal cancer at any site can lead to the upward metastasis, the upward lymph node dissection, up to the base of inferior mesenteric artery (the third line of lymph nodes), must be done in all rectal cases, otherwise, 10% of patients would have residual cancer. In view of the lateral metastasis occurring only in rectal cancers under the peritoneal reflection, for which lateral lymph node dissection is necessary or one eighth of patients would have residual lesion. Generally, no lateral lymph node dissection is needed in cancers above the peritoneal reflection. Pathologic factor influencing the lymphatic metastasis is the form of tumor growth, such as poorly differentiated and mucoid adenocarcinomas aggressively growing deeply and extensively resulting in a higher lymph node metastatic rate, for which lymph node dissection must be performed.
基于170例根治性切除的晚期直肠癌标本，研究其转移规律及淋巴结清扫范围，以指导未来的手术治疗。170例中，77例有淋巴结转移。淋巴结转移率为45.3%，转移度为8.9%（527/5912）。根据淋巴解剖学，直肠癌转移可分为向上、侧向和向下引流。由于任何部位的直肠癌均可导致向上转移，因此所有直肠癌病例均必须进行向上淋巴结清扫，直至肠系膜下动脉根部（第三站淋巴结），否则10%的患者会有癌残留。鉴于侧向转移仅发生于腹膜反折以下的直肠癌，对此必须进行侧向淋巴结清扫，否则八分之一的患者会有残留病变。一般来说，腹膜反折以上的癌无需进行侧向淋巴结清扫。影响淋巴转移的病理因素是肿瘤生长方式，如低分化腺癌和黏液腺癌生长深且广泛，导致淋巴结转移率较高，对此必须进行淋巴结清扫。
