切换至 "中华医学电子期刊资源库"

中华普外科手术学杂志(电子版) ›› 2022, Vol. 16 ›› Issue (03) : 339 -342. doi: 10.3877/cma.j.issn.1674-3946.2022.03.028

论著

中低位直肠癌侧方淋巴结阳性的危险因素分析
舒同1, 文红梅1, 周皓岚1, 黄涛1, 王胜猛1, 应俊2,()   
  1. 1. 636000 四川巴中,巴中市中医院普外科
    2. 200003 上海,上海长征医院肛肠外科
  • 收稿日期:2021-06-17 出版日期:2022-04-26
  • 通信作者: 应俊

Risk factors of positive lateral lymph nodes in middle and low rectal cancer

Tong Shu1, Hongmei Wen1, Haolan Zhou1, Tao Huang1, Shengmeng Wang1, Jun Ying2,()   

  1. 1. Department of General Surgery,Bazhong Municipal Hospital of Traditional Chinese Medicine,Bazhong Sichuan Province 636000,China
    2. Department of Anorectal Surgery,Shanghai Changzheng Hospital,Shanghai 200003,China
  • Received:2021-06-17 Published:2022-04-26
  • Corresponding author: Jun Ying
  • Supported by:
    Shanghai 2020 "Science and Technology Innovation Action Plan" Natural Science Fund Field Project(20ZR1432600); Special Project of Traditional Chinese Medicine of Sichuan Administration of Traditional Chinese Medicine(2020LC055)
引用本文:

舒同, 文红梅, 周皓岚, 黄涛, 王胜猛, 应俊. 中低位直肠癌侧方淋巴结阳性的危险因素分析[J/OL]. 中华普外科手术学杂志(电子版), 2022, 16(03): 339-342.

Tong Shu, Hongmei Wen, Haolan Zhou, Tao Huang, Shengmeng Wang, Jun Ying. Risk factors of positive lateral lymph nodes in middle and low rectal cancer[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2022, 16(03): 339-342.

目的

探讨影响中低位直肠癌侧方淋巴结阳性的危险因素。

方法

回顾性分析2019年1月1日至2020年12月30日两家医院102例中低位直肠癌行腹腔镜根治性切除并进行侧方淋巴结清扫术患者的临床资料,根据侧方淋巴结转移情况将其分为阳性组(n=21例)和阴性组(n=81例)。临床数据采用SPSS 22.0软件进行统计学分析,计数资料以[n(%)]表示,采用χ2Fisher精确检验;侧方淋巴结阳性的危险因素采用Logistic多因素分析。以P<0.05为差异有统计学意义。

结果

102例中低位直肠癌患者侧方淋巴结清扫总数为1347枚,其中阳性淋巴结占比为8.1%;单因素分析结果显示,患者年龄、肿瘤直径、分化程度、肿瘤类型、T分期及浸润肠壁程度与侧方淋巴结阳性的发生均有明显相关性(P<0.05);Logistic回归分析显示,低分化、浸润型、T3-4期及浸润肠壁浆膜外肿瘤是中低位直肠癌侧方淋巴结阳性的独立危险因素(P<0.05)。

结论

中低位直肠癌患者肿瘤组织低分化、浸润型癌、肿瘤分期T3-4及浸润肠壁浆膜外可作为判断侧方淋巴结转移的独立危险因素,建议对存在这些危险因素的患者行侧方淋巴结清扫术。

Objective

To investigate the risk factors of lateral lymph node positivity in middle and low rectal cancer.

Methods

The data of 102 patients with middle and low rectal cancer who underwent laparoscopic radical resection and lateral lymph node dissection from January 1,2019 to December 30,2020 were retrospectively analyzed,and they were divided into positive group(n=21cases)and negative group(n=81cases)according to the lateral lymph node metastasis. The clinical data were statistically analyzed by SPSS 22.0 software,and the count data were expressed as[n(%)],using χ2 or Fisher's exact test. Logistic multifactor analysis was used for risk factors of positive lateral lymph nodes,and P<0.05 was considered as statistically significant difference.

Results

A total of 1347 lateral lymph nodes were dissected in 102 patients with low and middle rectal cancer,and 8.1% of them were positive lymph nodes. Univariate analysis showed that age,tumor diameter,degree of differentiation,tumor type,T stage and degree of intestinal wall invasion were significantly correlated with the occurrence of lateral lymph nodes(P<0.05). Logistic regression analysis showed that the degree of low differentiation,invasive type,T3-4 stage and extrapserous tumor infiltrating intestinal wall were independent risk factors for positive lateral lymph nodes in low and middle rectal cancer(P<0.05).

Conclusion

Low differentiation of tumor tissue,invasive cancer,tumor stage T3-4 and infiltration of intestinal wall beyond serous membrane in patients with low and medium rectal cancer can be used as independent risk factors for lateral lymph node metastasis,and lateral lymph node dissection is recommended for patients with these risk factors.

表1 102例中低位直肠癌患者侧方淋巴结清扫情况(枚)
表2 102例中低位直肠癌患者临床病理特征与侧方淋巴结转移单因素分析(例)
表3 中低位直肠癌患者侧方淋巴结阳性的多因素Logistic回归分析
[1]
Cao WChen HDYu YW,et al. Changing profiles of cancer burden worldwide and in China:a secondary analysis of the global cancer statistics 2020[J]. Chin Med J2021134(7):783-791.
[2]
Park IJKim JC. Intersphincteric Resection for Patients With Low-Lying Rectal Cancer:Oncological and Functional Outcomes[J]. Ann Coloproctol201834(4):167-174.
[3]
Jankowski MLas-Jankowska MRutkowski A,et al. Clinical Reality and Treatment for Local Recurrence of Rectal Cancer:A Single-Center Retrospective Study[J]. Medicina(Kaunas)202157(3):286.
[4]
Meyer JChristou NCombescure C,et al. Does lateral lymph node dissection for low rectal cancer improve overall survival?Protocol for a systematic review and meta-analysis[J]. Int J Surg Protoc201917:1-2.
[5]
Morohashi HSakamoto YMiura T,et al. Short-term outcomes of robotic-assisted laparoscopic versus laparoscopic lateral lymph node dissection for advanced lower rectal cancer[J]. Surg Endosc202135(9):5001-5008.
[6]
池畔,官国先. 腔镜直肠癌根治术侧方淋巴结清扫的关键技术与意义[J/CD]. 中华普外科手术学杂志(电子版)201913(1):5-7.
[7]
Danihel LJrRajcok MMosna K,et al. MRIbased neoadjuvant therapy indication in middle and low rectal cancer[J]. Bratisl Lek Listy2019120(9):663-667.
[8]
Sun YWu XLin H,et al. Lymph Node Regression to Neoadjuvant Chemoradiotherapy in Patients with Locally Advanced Rectal Cancer:Prognostic Implication and a Predictive Model[J]. J Gastrointest Surg202125(4):1019-1028.
[9]
Akiyoshi TToda STominaga T,et al. Prognostic impact of residual lateral lymph node metastasis after neoadjuvant(chemo)radiotherapy in patients with advanced low rectal cancer[J]. BJS Open20193(6):822-829.
[10]
中国医师协会内镜医师分会腹腔镜外科专业委员会,中国医师协会结直肠肿瘤专业委员会腹腔镜专业委员会,中华医学会外科学分会结直肠外科学组. 中国直肠癌侧方淋巴结转移诊疗专家共识(2019版)[J]. 中华胃肠外科杂志201922(10):901-912.
[11]
Xu HZhao WGuo W,et al. Prediction Model Combining Clinical and MR Data for Diagnosis of Lymph Node Metastasis in Patients With Rectal Cancer[J]. J Magn Reson Imaging202153(3):874-883.
[12]
Hiyoshi YMiyamoto YKiyozumi Y,et al. Risk factors and prognostic significance of lateral pelvic lymph node metastasis in advanced rectal cancer[J]. Int J Clin Oncol201925(1):110-117.
[13]
Kong JCGuerra GRWarrier SK,et al. Prognostic Value of Tumour Regression Grade in Locally Advanced Rectal Cancer A Systematic Review and Meta-analysis[J]. Colorectal Dis201820(7):574-585.
[14]
Xiao LRong-Che OU. Correlation Between ADC Value of Diffusion-weighted Imaging and Differentiation Degree and T Stage of Rectal Cancer[J]. Chinese Journal of CT and MRI201917(8):35-37.
[15]
Tanishima HKimura MTominaga T,et al. Lateral lymph node metastasis in a patient with T1 upper rectal cancer treated by lateral lymph node dissection:a case report and brief literature review[J]. Surg Case Rep20173(1):93.
[16]
Fields ACLu PHu F,et al. Lymph Node Positivity in T1/T2 Rectal Cancer:a Word of Caution in an Era of Increased Incidence and Changing Biology for Rectal Cancer[J]. J Gastrointest Surg202025(4):1029-1035.
[1] 王振宁, 杨康, 王得晨, 邹敏, 归明彬, 王雅楠, 徐明. 机器人与腹腔镜手术联合经自然腔道取标本对中低位直肠癌患者远期疗效比较[J/OL]. 中华普通外科学文献(电子版), 2024, 18(06): 437-442.
[2] 赵丽霞, 王春霞, 陈一锋, 胡东平, 张维胜, 王涛, 张洪来. 内脏型肥胖对腹腔镜直肠癌根治术后早期并发症的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 35-39.
[3] 吴晖, 佴永军, 施雪松, 魏晓为. 两种解剖入路下行直肠癌侧方淋巴结清扫的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 40-43.
[4] 周世振, 朱兴亚, 袁庆港, 刘理想, 王凯, 缪骥, 丁超, 汪灏, 管文贤. 吲哚菁绿荧光成像技术在腹腔镜直肠癌侧方淋巴结清扫中的应用效果分析[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 44-47.
[5] 徐逸男. 不同术式治疗梗阻性左半结直肠癌的疗效观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 72-75.
[6] 李代勤, 刘佩杰. 动态增强磁共振评估中晚期低位直肠癌同步放化疗后疗效及预后的价值[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 100-103.
[7] 贺斌, 马晋峰. 胃癌脾门淋巴结转移危险因素[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 694-699.
[8] 庄宝雄, 邓海军. 单孔+1腹腔镜直肠癌侧方淋巴结清扫术[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 601-601.
[9] 林凯, 潘勇, 赵高平, 杨春. 造口还纳术后切口疝的危险因素分析与预防策略[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 634-638.
[10] 严虹霞, 王晓娟, 张毅勋. 2 型糖尿病对结直肠癌患者肿瘤标记物、临床病理及预后的影响[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 483-487.
[11] 赵磊, 刘文志, 林峰, 于剑, 孙铭骏, 崔佑刚, 张旭, 衣宇鹏, 于宝胜, 冯宁. 深部热疗在改善结直肠癌术后辅助化疗副反应及生活质量中的作用研究[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 488-493.
[12] 陈杰, 武明胜, 李一金, 李虎, 向源楚, 荣新奇, 彭健. 低位直肠癌冷冻治疗临床初步分析[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 494-498.
[13] 黄海洋, 邝永龙, 陈嘉胜. 基层医院结直肠肿瘤经自然腔道取标本手术30 例分析[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 510-518.
[14] 王灿, 樊昊, 张卫, 于冠宇. LARS 评分的研制回顾与应用现状[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 519-523.
[15] 颜世锐, 熊辉. 感染性心内膜炎合并急性肾损伤患者的危险因素探索及死亡风险预测[J/OL]. 中华临床医师杂志(电子版), 2024, 18(07): 618-624.
阅读次数
全文


摘要