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目的探讨右半结肠癌淋巴结转移规律。方法前瞻性入组2012年10月至2014年12月在北京大学人民医院行完整结肠系膜切除(CME)的病人,按照日本《大肠癌诊疗规范》(第7版)进行淋巴结分站取材和病理学检查,分析阳性淋巴结分布规律、影响淋巴结转移的临床病理因素。结果右半结肠癌肠旁、中间、中央淋巴结转移发生率分别33.0%、18.3%、16.5%(P=0.005),肠旁淋巴结转移主要位于距离肿瘤<10 cm以内组织,但是>10 cm组织(1.7%)仍有淋巴结转移。淋巴结转移发生率与肿瘤T分期和分化程度有关。T3~T4期病人淋巴结转移发生率,高于T1~T2期(46.2%vs.9.1%,P<0.05)。低分化及未分化癌淋巴结转移发生率为64.7%,明显高于高分化癌(0)、中分化癌(36.0%),P<0.05,且分化程度越差更易出现肠旁及中央淋巴结转移。幽门下组淋巴结转移发生率为2.6%(3/115),且均为结肠肝曲癌。14.8%(17/115)的病人出现跳跃性淋巴结转移。结论右半结肠癌淋巴结转移存在于肠旁、中间、根部系膜组织,术中应常规清扫,结肠肝曲癌还应清扫幽门下淋巴结,CME有助于彻底清扫该区域淋巴结。
Objective To investigate the rule of lymph node metastasis in right colon cancer. Methods Prospective enrollment From October 2012 to December 2014, patients undergoing complete mesorectal excision (CME) at People’s Hospital of Peking University were enrolled in this study. According to the Japan Criteria for Diagnosis and Treatment of Colorectal Cancer (7th edition) Physical examination, analysis of the distribution of positive lymph nodes, affecting the clinical pathological factors of lymph node metastasis. Results The incidence of intestinal metaplasia, middle and central lymph node metastasis in the right colon of the right colon were 33.0%, 18.3% and 16.5% (P = 0.005), respectively. The intestinal metaplastic lymph node metastasis was mainly located within 10 cm away from the tumor but> 10 cm 1.7%) still have lymph node metastasis. The incidence of lymph node metastasis and tumor T stage and degree of differentiation. The incidence of lymph node metastasis in stage T3 ~ T4 was higher than that in stage T1 ~ T2 (46.2% vs.9.1%, P <0.05). The incidence of lymph node metastasis in poorly differentiated and undifferentiated carcinoma was 64.7%, which was significantly higher than that in well differentiated carcinoma (0), moderately differentiated carcinoma (36.0%), P <0.05, and the worse the differentiation was, the easier the intestinal metaplasia and central lymph node metastasis occurred. The incidence of lymph node metastasis in the lower pyloric group was 2.6% (3/115), and all were colonic cancers. 14.8% (17/115) of the patients showed jumpy lymph node metastasis. Conclusions The right colon cancer with lymph node metastasis exists in the mesenteric tissue of the intestine, middle and root. The colon should be routinely dissected. The colorectal carcinoma should be cleaned of pyloric lymph nodes. CME can help to clear the lymph nodes in the area.