The Analysis Of Lymph Nodes Metastasis Around The Root Of Inferior Mesenteric Artery In Resection Of Rectal Cancer

Objective: To investigate the metastasis of basic mesenteric artery IMA in rectal cancer patients by collecting the clinical data of rectal cancer patients in our hospital,and to explore the significance of lymph node dissection in rectal cancer radical surgery.Methods: A retrospective clinical analysis was performed by collecting clinical data from 227 patients with rectal cancer diagnosed from November 2014 to November 2010 in our department undergoing subconjunctival artery lymph node dissection.All patients with rectal cancer underwent radical resection of rectal cancer.The IMA root lymph node(D3 station)was cleaned and the lymph nodes were cleaned.The clinical data were used to analyze the positive incidence of IMA root lymph nodes and the age,sex,The relationship between the location of CEA and the level of CEA was analyzed.The data were analyzed by SPSS 19.0 software.The single factor analysis was performed by χ~2test with p = 0.05 As a test level.Results: A total of 227 patients were included in the study.Among them,the number of lymph node metastasis of the inferior mesenteric artery was 31 cases and the metastasis rate was 13.7%.A total of 549 lymph nodes were collected.The average number of lymph nodes was 2.42(1 to 9),Of which there are 118 metastatic lymph nodes,metastatic degree of 21.5%.The metastasis rate was 9.8%,84 cases were transferred in 17 cases,the metastasis rate was 20.2%(χ~2 = 1.025,p = 0.311),and 137 cases were transferred from 18 cases of male patients(N = 0.779).The metastasis rate was 14.3%,and the metastasis rate was 14.3% in 77 patients with open rectal cancer radical surgery.The metastasis rate was 13.1% and 14.4%(χ~2= 0.79,p = 0.779).The primary tumor was located in 96 patients with peritoneal reflex and 22 patients undergoing retroperitoneal 9 patients with metastatic rate of 22.9%,6.9%(χ~2= 12.098,p<0.001);tumor accounted for peritumoral diameter ≥ 1/2 weeks in 151 patients with metastatic 26 cases,the tumor accounted for intestinal circumference <1 / Themetastasis rate was 17.2% and 7.04%(χ~2= 4.853,p = 0.028).Fifty-nine patients with tumor diameter ≥5cm were transferred in 13 patients with tumor diameter <5cm168cases,Metastasis rate was 22% and 10.7%(χ~2 = 4.745,p = 0.029).The number of patients with ulcer type,uplift and infiltrating type were 129 cases,44 cases and 54 cases.The patients were divided into two groups: control group(n = 12)and normal control group(n = 21).The rate of metastasis was 12.4%,13.6%,16.7(χ~2 = 0.587,p =0.746),The number of metastases was 0 cases,18 cases and 13 cases respectively.The transfer rates were 0%,11.4% and 27.1%(χ~2 = 11.347,p = 0.03)respectively.The number of patients with p T1 and T2 were : 13,50,the transfer rate of 0 transfer rate of0%.The metastatic rate was 13.9% in 63 patients with p T3 stage,and 63 patients in p T4 patients were metastatic rate of 26.98%(χ~2 = 19.458,p <0.001).The mesenteric vascular root between p T3 and p T4(χ~2= 4.359,p = 0.037 <0.05).There were 31 cases(25.8%)of patients with vascular tumor thrombus group and 196 cases with no vascular tumor thrombus group.There were statistically significant differences in lymph node metastasis rate(χ~2 = 4.495,p = 0.034).There were 216 cases(P <0.05),but there was no significant difference between the two groups(P <0.05),but there was no significant difference between the two groups(P> 0.05)23 cases of lymph node metastasis,the transfer rate was 10.6%,the number of cases of liver metastases occurred in 11 cases of lymph node metastasis in 8 patients,the transfer rate was 34.8%(χ~2= 34.209,p <0.001);preoperative CEA <5ng / ml The number of cases was 17 cases,and the metastasis rate was 10.4% and 22.2%(χ~2 = 5.426,p = 0.020).The number of patients with CEA≥5ng /ml was 63 cases.Conclusion: Clinical factors affecting the lymph node metastasis of IMA: preoperative CEA level(≥5ng / ml),tumor diameter(more than 5cm),accounting for peritumoral diameter(more than 1/2 weeks),tumor location(peritoneal fold),differentiation(Poorly differentiated),the emergence of vascular cancer thrombus,liver metastasis,degree of infiltration(T3-T4).If rectal cancer patients with the above factors should be routine intraoperative IMA root lymph node dissection,reduce tumor recurrence rate.