摘要目的 探讨直肠癌标本获取的淋巴结数对病理分期的影响.方法 将2007年1月至2008年6月接受全直肠系膜切除术的直肠癌患者的手术标本随机分为两组:常规组(n=39),肉眼下用手触摸获取淋巴结;脂肪清除组(n=36),用脂肪清除剂浸泡24 h后再获取淋巴结.比较两组所获取的淋巴结数量,分析其转移情况及病理分期.结果 本研究入组患者共75例,男性42例,女性33例,平均年龄53.2岁.常规组平均每例标本检出14.4(8～27)枚淋巴结;脂肪清除组平均检出36.2(14～62)枚淋巴结,两组差异有统计学意义(t=5.800,P＜0.05).常规组和脂肪清除组T1期分别为4例和5例,T2期分别为9例和6例,T3期分别为24例和22例,T4期分别为2例和3例;两组差异均无统计学意义(Z=0.160,P=0.850).常规组平均每例标本转移淋巴结数为1.5枚,而脂肪清除组为3.2枚,两组差异有统计学意义(Z=3.500,P＜0.05).常规组区域淋巴结为N0、N1、N2者分别为20、12、7例,而脂肪清除组则分别为9、14、13例,两组差异有统计学意义(Z=2.410,P=0.016).结论直肠癌全系膜切除术后标本淋巴结数量变异较大,直肠癌系膜淋巴结转移不但与分期相关,而且与淋巴结数量相关;目前以12枚淋巴结衡量其系膜完整切除与否及病理分期的精准度可能存在问题.

abstractsObjective To investigate the influence of lymph nodes detection on the pathological staging in rectal cancer specimens.Methods From January 2007 to June 2008,75 patients with rectal cancer who underwent total mesorectal excision were randomly dirided into two groups:conventional group (n=39),in which lymph nodes were detected by sight and palpation;fat clearance group(n=36),in which lymph nodes were harvested after the specimens immersed in a fat clearance solution for 24 hours.The lymph node number harvested was compared between the two groups,and metastasis of the lymph nodes and its impact on the pathologic staging was analyzed in the two groups.Results A total of 75 patients(42 male and 33 female,the average age was 53.2 years)were enrolled in this study.In the conventional group,a mean of 14.4 lymph nodes(range,8-27)was detected,and was significantly less than that in fat clearance group(mean 36.2,range,18-62)(t=5.800,P＜0.05).The tumor invasion was classified as T1 in 4 cases and 5 cases,T2 in 9 cases and 6 cages.T3 in 24 cases and 22 cases and T4 in 2 cases and 3 cases in conventional group and fat clearance group,respectively. No significant difference was found in T classification between the two groups(Z=0.160,P=0.850).The mean number of metastatic lymph nodes harvested in conventional group wag 1.5,and it was 3.2 in the fat clearance group(Z=3.500,P＜0.05).According to the regional lymph nodes,patients classifled as NO,N1 and N2 were 20,12,7 cases in conventional group.and were 9,14,13 cases in the fat clearance group,respectively;and there was significant difference between the two groups(Z=2.410,P=0.016).Conclusions The variation of the number of harvested lymph nodes in surgical specimens from rectal cancer after total mesorectal excision is great.The metastasis of mesorectal lymph nodos is not only associated with the tumor staging.but also related to the number of harvested lymph nodes.It is questionable that 12 lymph nodes is currently seen as enough to evaluate the pathologic staging for rectal Cancer.