直肠癌全直肠系膜切除术系膜切缘微转移的临床研究  

Detecting mesorectal margin micrometastasis in total mesorectal excision patients with rectal carcinoma

作　　者：程伏林[1] 周云峰[1] 魏正专[1] 杨国梁[1] 

机构地区：[1]武汉大学中南医院肿瘤科湖北省肿瘤生物学行为重点实验室湖北省肿瘤临床医学研究中心,湖北武汉430070

出　　处：《中华普通外科杂志》2009年第3期215-217,共3页Chinese Journal of General Surgery

基　　金：湖北省自然科学基金（2006ABA213）;湖北省卫生厅基金资助项目（w201529）.

摘　　要：目的对直肠癌患者系膜切缘微转移灶进行检测，研究其对局部复发的影响。方法对52例DukesA、B和C期直肠癌患者实施全直肠系膜切除术，用RT-PCR技术检测系膜切缘组织细胞中角质蛋白CK20 mRNA。结果本组52例直肠癌旁系膜中，21例CK20 mRNA呈阳性，31例为阴性，总阳性率为40％。Dukes A、B和C期阳性率分别为17％、30％和54％，直肠系膜切缘微转移发生率随肿瘤分期升高而增加，组间比较差异有统计学意义，P〈0.05；高、中、低与未分化癌阳性表达率分别为43％、38％、40％和50％，病理分级之间CK20 mRNA表达阳性率差异无统计学意义（P〉0.05）。全组患者局部复发率为12％，CK20 mRNA阳性组和阴性组局部复发率分别为24％和3％，两组比较差异有统计学意义，P〈0.05。结论直肠系膜切缘微转移与局部复发有关，提示系膜CK20 mRNA可能是一个潜在的局部复发标志物。Objective To evaluate the impact of mesorectal margin micrometastasis on local recurrence of rectal carcinoma after total mesorectal excision, and the relation between mesorectal margin micrometastasis and local recurrence. Methods Mesorectal margin specimens from 52 cases of rectal cancer after total mesorectal excision were studied by reverse transcriptase-polymerse chain reaction（RT-PCR） to detect the expression of CK20 mRNA. These patients were divided into CK20 mRNA positive and negative group and followed up for 3 years until local recurrence developed. Results In 52 patients with rectal cancer,21 cases were found to express CK20 mRNA in mesorectal margin, the expression rate of CK20 mRNA in Dukes A, B and C was 17% ,30% and 54%（P〈0.05） , respectively. The positive rate of well differentiated, moderately differentiated, poorly differentiated and undifferentiated carcinomas were 43%, 38% ,40% and 50%, respectively（P〉0.05）. The incidence of local recurrence in CK20 mRNA positive and negative group was 24% and 3% , respectively. The difference was statistically significant between the two groups（P〈0.05）. Conclusion Detection of mesorectal margin CK20 mRNA as micrometastasis by RT-PCR in rectal carcinoma patients was a sensitive and effective way in predicting local recurrence. It is necessary for patients with positive mesorectal margin CK20 mRNA to undergo postoperative radiotherapy after total mesorectal excision.

关 键 词：直肠肿瘤 肿瘤转移 肿瘤复发 局部 角蛋白20 

分 类 号：R686[医药卫生—骨科学]