直肠癌系膜切缘和盆腔侧方转移规律的研究及生存分析  

Patterns and prognostic value of resection margin involvement and lateral pelvic metastases for patients with rectal cancer

作　　者：王存[1] 周总光[1] 徐丹[2] 于永扬[1] 程中[1] 李立[1] 

机构地区：[1]四川大学华西医院消化外科研究室,成都610041 [2]四川大学华西医院呼吸病研究室,成都610041

出　　处：《中华胃肠外科杂志》2006年第6期474-476,共3页Chinese Journal of Gastrointestinal Surgery

基　　金：国家杰出青年基金(39925032)

摘　　要：目的研究直肠癌系膜切缘和盆腔侧方转移的规律,为合理施行外科手术提供病理学依据。方法运用大组织切片技术,研究62例手术标本,并分析随访资料。结果有8例(12．9%)标本判定为环周切缘肿瘤浸润(CMI),其术后无病生存率低于切缘无肿瘤者(P=0．003)。12例(19．4%)标本存在盆腔侧方区域肿瘤转移,其中有8例(66．7%)为单一区域受累,4例(33．3%)为多重区域受累；术后无病生存率低于直肠系膜转移及无转移者(P=0．026)。本组盆腔侧方区域肿瘤转移中以直肠中动脉根部受累率最高(6/12,50．O%),其次为髂内动脉部(4/12,33．3%)和闭孔动脉区(3/12,25．0%)。结论直肠系膜CMI和盆腔侧方癌转移对直肠癌患者的术后生存时间有影响,应合理制定手术清扫范围,选用术后辅助治疗。Objective To study the patterns and prognostic value of resection margin involvement and lateral pelvic metastases, providing surgeons with pathologic proofs of tumor spread within the studied areas. Methods Large tissue slices of 62 specimens from patients with rectal cancer were used in the pathologic study and the outcomes were followed. Results Compared with patients without margin involvement, patients with circumferential margin involvement （CMI）, seen in 8 cases （12.9%）, had poorer postoperative survival （P = 0.003）. The 12 patients （19.4%） with lateral pelvic metastases suffered poorer survival, compared with those without lateral pelvic metastases （P = 0.026）. Eight patients （66.7%） were diagnosed to have single lateral pelvic region involved, while the other 4 had multiple regions involved. The incidence of lateral metastases differed among regions, with higher occurrence in the root of middle rectal artery （6/12, 50.0%）, area of the internal iliac artery （4/12, 33.3%） and the obturator region （3/12, 25.0%）. Conclusion Occurrence of CMI or lateral metastases in rectal cancer patients predispose poor survival, thus a more radical clearance and postoperative adjuvant therapy are recommended.

关 键 词：直肠肿瘤 肿瘤转移 外科手术 无病生存 

分 类 号：R735.37[医药卫生—肿瘤]