作者：王励之1，许开武1，李军1，卢太亮1，李美梁2，陈超武1

单位：1.湖南师范大学附属第一医院 胃肠外科，湖南 长沙 410000；2.湖南师范大学附属第一医院 病理科，湖南 长沙 410000

Authors: Wang Lizhi1，Xu Kaiwu1，Li Jun1，Lu Tailiang1，Li Meiliang2，Chen Chaowu1

Unit: 1.Department of Gastrointestinal Surgery, the First Affiliated Hospital of Hunan Normal University, Changsha

413000, Hunan, China；2.Department of Pathology, the First Affiliated Hospital of Hunan Normal University, Changsha 413000, Hunan,China

摘要：

目的 探讨低位直肠癌患者的直肠侧韧带淋巴结发生癌转移的临床病理危险因素。方法 收集2016年1月至2020年8月湖南省人民医院胃肠外科接受腹腔镜下直肠癌根治术的113例低位直肠癌患者的临床病理资料,分析患者性别、年龄、体质量指数(body mass index, BMI)、直肠侧韧带缺失情况、术前梗阻、肿瘤长径、肿瘤组织病理类型、肿瘤大体类型、肿瘤分化程度、术前肿瘤标志物水平、肿瘤T分期、肿瘤微卫星稳定状态、Ras基因型等临床病理因素与直肠侧韧带中淋巴结发生癌转移的相关性,并纳入多因素Logistic回归分析模型进行分析。结果 22例患者的直肠侧韧带中发现癌转移淋巴结,转移率为19.47%。单因素分析显示:术前梗阻(P=0.025)、肿瘤T分期(P=0.039)、存在脉管内癌栓(X2=23.611,P<0.001)是直肠侧韧带中淋巴结发生癌转移的危险因素。多因素分析显示脉管瘤栓(OR=10.18,P=0.008)是直肠侧韧带发生癌转移的独立危险因素。结论 术前梗阻、肿瘤T分期、脉管瘤栓等三项临床病理因素是低位直肠癌患者的直肠侧韧带中淋巴结发生癌转移的危险因素。存在脉管瘤栓是低位直肠癌患者的直肠侧韧带中淋巴结发生癌转移的独立危险因素。

关键词：低位直肠癌；直肠侧韧带；直肠癌侧方淋巴结清扫；临床病理因素

Abstract：

Objective To study the risk factors on lymph metastasis in the lateral ligament of rectum by analyzing the clinicopathological factors of low rectal cancer patients. Methods We recruited low rectal cancer patients who were operated for laparoscopic radical surgery from January 2016 to August 2020 according to the inclusion criteria, and we collect the clinicopathological data of these recruited patients. The data comes from gender, age, body mass index, preoperative obstruction, number of lateral ligament of rectum, tumor markers(CEA, CA19-9 and CA72-4), tumor size, gross types, histopathology, differentiations, lymphovascular invasion, perineural invasion, T stage, number of lymph nodes harvested,  microsatellite status and Ras genetic mutation status. we will use the Chi-square test or Fisher test and multivariate logistic regression models to identify the association between lymph node metastasis in lateral ligament of rectum and the data. Results We recruited 113 patients and find out lymph metastasis in 22 patients爷lateral ligament of rectum. Univariate analysis showed we knows that patients with some particular characteristics are more likely to have lymph metastasis in lateral ligament of rectum from univariate analysis, the characteristics including preoperative obstruction ( P=0.025) , T stage ( P=0.039) and lymphovascular invasion (X2=23.611, P<0.001) . We also knows that patients with lymphovascular invasion (OR=10.18, P=0.008) were more prone to lymph metastasis in lateral ligament of rectum from multivariate logistic regression models. Conclusion Three clinicopathological factors, including preoperative intestinal obstruction , tumor T stage and vascular tumor thrombus,are the risk factors for lymph node metastasis in the lateral rectal ligament of low rectal cancer patients.Logistic analysis shows that the presence of vascular tumor thrombus and is an independent risk factor for lymph node metastasis in the lateral rectal ligament of low rectal cancer patients.

Key Words: Low rectal cancer；Lateral ligament of rectum；Lateral lymph node dissection；Clinicopathological factors