T1期乙状结肠癌淋巴结转移的分布:是否结扎肠系膜下动脉?

• 作 者: Kawamura Y.J. Sakuragi M. Togashi K. 樊菁
• 机 构: Department of Surgery Omiya Medical Center Jichi Medical School 1- 847 Amanuma- cho Saitama- shi Sa
• 出 处: 世界核心医学期刊文摘(胃肠病学分册)
• 发表日期: 2005年12期
• 关键词: 肠系膜下动脉 乙状结肠癌 淋巴结转移 乙状结肠动脉 左结肠动脉 直肠上动脉 肿瘤切除术 淋巴结切除 局部淋巴结转移 侵入深度

Objective. In standard oncological sigmoid colectomy, the inferior mesenteric artery is ligated either at its origin or at the level of the left colic artery. However, in patients with earlystage carcinoma, the distribution of metastatic nodes may be limited. The aim of this study was to clarify the prevalence and distribution of lymph node metastasis in T1 sigmoid colon carcinoma and to determine the adequate range of lymph node dissection. Material and methods. The study included 121 consecutive patients treated for T1 sigmoid colon carcinoma. Clinicopathologic factors associated with nodal metastasis and the distribution of metastatic nodes were analyzed. Results. Of 121 patients, 12 (10% ) had nodal involvement. The depth of invasion and the presence of lymphatic and vascular invasion were significantly associated with nodal metastasis. Of these 12 patients, 11 (92% ) had lymph node metastasis confined to pericolic nodes. Nodes along the sigmoidal artery were involved in one patient. There was no involved node along the superior rectal artery or at the root of the inferior mesenteric artery. Conclusions. Lymph node dissection for T1 sigmoid colon carcinoma should be limited to the root of the sigmoidal artery, and the inferior mesenteric artery should be preserved.

In standard oncological sigmoid colectomy, the inferior mesenteric artery is ligated either at its origin or at the level of the left colic artery. However, in patients with earlystage carcinoma, the distribution of metastatic nodes may be limited. The aim of this study was to clarify the prevalence and distribution of lymph node metastasis in T1 sigmoid colon carcinoma and to determine the adequate range of lymph node dissection. Material and methods. The study included 121 consecutive patients treated for T1 sigmoid colon carcinoma. Clinicopathologic factors associated with nodal metastasis Of 121 patients, 12 (10%) had nodal involvement. The depth of invasion and the presence of lymphatic and vascular invasion were significantly associated with nodal metastasis. Of these 12 patients, 11 ( 92%) had lymph node metastasis confined to pericolic nodes. Nodes along the sigmoidal artery were involved in one patien t. There was no involved node along the superior rectal artery or at the root of the inferior mesenteric artery. Conclusions. Lymph node dissection for T1 sigmoid colon carcinoma should be limited to the root of the sigmoidal artery, and the inferior mesenteric artery should be preserved.