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目的探讨中、老年直肠癌患者直肠癌扩大根治术的可行性,并分析各组淋巴结的转移规律。方法接受保留盆腔自主神经的直肠癌扩大根治术97例,其中传统开腹直肠癌扩大根治术85例,腹腔镜辅助下的直肠癌扩大根治术12例,清除淋巴结以常规病理学方法(HE染色)观察。结果 97例患者中有39例发生淋巴结转移,有10例发生了侧方淋巴结转移,共取出淋巴结2 036枚,平均清除淋巴结21.0枚,转移淋巴结169枚,总淋巴结转移率为40.2%(39/97),侧方淋巴结转移率10.3%(10/97)。结论直肠癌的淋巴转移以肿瘤旁直肠系膜转移为主,肠系膜下动脉根部及侧方淋巴结转移率低。中、老年直肠癌患者中分化较差及T3、T4的患者侧方淋巴结转移的可能性明显增加,TME基础上加行侧方淋巴结清扫,无论是传统开腹扩大根治术还是腹腔镜辅助下的扩大根治术对于老年患者都安全可行,并不增加并发症的发生率。
Objective To investigate the feasibility of extended radical mastectomy for rectal cancer in the elderly patients with rectal cancer and to analyze the rule of lymph node metastasis in each group. Methods Ninety-seven patients underwent extended radical mastectomy for rectal cancer preserving pelvic autonomic nerve. Eighty-five patients underwent radical mastectomy with traditional open rectal cancer and 12 patients underwent laparoscopic radical mastectomy. The lymph nodes were removed by routine pathology (HE staining )Observed. Results Of the 97 patients, 39 had lymph node metastasis and 10 had lateral lymph node metastasis. A total of 2 036 lymph nodes were removed, 21.0 were removed, 169 were metastatic lymph nodes, and the total lymph node metastasis rate was 40.2% (39 / 97). Lateral lymph node metastasis rate was 10.3% (10/97). Conclusion Lymphatic metastasis of rectal cancer is mainly mesorectal metastasis of tumor, and the metastasis rate of root and lateral lymph node of inferior mesenteric artery is low. In elderly patients with poorly differentiated rectal cancer and T3, T4, the possibility of lateral lymph node metastasis was significantly increased TME based on the line side lymph node dissection, whether it is the traditional open radical gastrectomy or laparoscopic assisted Extended radical mastectomy is safe and feasible in elderly patients, does not increase the incidence of complications.