右半结肠癌外科干淋巴结规律及对临床预后的影响.doc

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1、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：T]0、T219.4%、T320.3%>T4

2、41.9%和口0、T?13.0%、TJ3.7%、T424.2%,外科干淋巴结转移数冃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(pv().()5)。结论淋巴结的转移率随肿瘤浸润深度增加而增加，口期肿瘤患者有较高的外科干淋巴结转移率，对低分化癌、肿瘤浸润超过口者主张把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Principleoflymphnodemetastasisandeffectofsurgicaltrunklymphnodesexcisiononprognosisinrighthemicoloniccarc

3、inoma[Abstract]ObjectiveToinvestigatetheprincipleoflymphmetastasisandevaluatetheeffectofsurgicaltrunklymphnodesexcisionontheclinicalprognosisinrighthemicoloniccarcinoma.MethodsPathologicaldataof183patientswithrighthemicoloniccarcinomawereanalyzed.ThelymphnodeswereclassifiedbyJapaneseCl

4、inicalPathologicalRulesofcoloncancer.Theclinicopathologicalcharacteristicsandclinicalprognosiswereanalysised.ResultsMetastaticlymphnodeswerefoundin91patientsamong183patientswithcoloncarcinoma.Themetastaticratewas49.7%Jnatatolretrievedandexamined2665lymphnodes(689surgicaltrunklymphnodes

5、wereincluded),429lymphnodes(16.1%)showedmetastasis,surgicaltrunklymphnodesshowedmetastasisin19patients.Themetastaticrate>incidenceofsurgicaltrunklymphnodeswas()>15.3%>3().1%、41.2%and()>14.3%>22.4%、50.5%inT]T2T3T4stagetumorsrespectively.The5-yearsurvivalrateofpatientswithsuricaltrunklym

6、phnodes(+)lessthan2wasmuchhigherthanthatofpatientswithsuricaltrunklymphnodes(+)morethan3(p<0.05).ConclusionsAsthedepthoftumorinvasionisincreased,themetastaticrateoflymphnodesaremarkedlyincreased.AhighrateofmetastasishasbeendemonstratedinsurgicaltrunklymphnodesinT4stageofrighthemicoloni

7、ccarcinoma.D3radicalresectionshouldbeperformedforthetumorwithpoorlydifferentiationandinvasionaboveT4【Keywords]ColonicneoplasmsLymphnodeexcisionTreatmentoutcome淋巴结转移是影响结肠癌患者预后的重要因素，也是导致患者术后复发、死亡的重要原因。术中规范清扫淋巴结与切除肿瘤同样重要，本文回顾分析我院实行根治手术并具有完整临床病理资料的右半结肠癌病例，探讨外科干淋巴结转移与患者预后的关系，为外科手术治疗提供参考。资