中低位直肠癌直肠系膜转移的临床观察  

Clinical observation for mesorectal metastasis of middle and lower rectal cancer

作　　者：吴文涌[1] 孟翔凌[1] 

机构地区：[1]安徽医科大学第一附属医院普外科,合肥230022

出　　处：《安徽医科大学学报》2010年第1期96-98,共3页Acta Universitatis Medicinalis Anhui

摘　　要：目的探讨中低位直肠癌系膜转移的临床病理特征,为中低位直肠癌的临床治疗提供病理学依据。方法回顾性分析中低位直肠癌患者46例,均以全直肠系膜切除(TME)原则手术治疗,手术标本制作成HE染色病理大组织切片,显微镜观察直肠系膜转移情况。结果直肠系膜转移率为67.4%(31/46);环周切缘癌浸润率(CMI)为21.7%(10/46),高、中分化分别为10%(1/10)、14.8%(4/27),明显低于低分化的55.6%(5/9)(P<0.05),A期为0/15,明显低于B期和C期的27.8%(5/18)和38.5%(5/13)(P<0.05);经腹超低位前切除术系膜远端切缘癌浸润(DMMI)为60%(3/5),明显高于经腹会阴联合切除术0/9(P<0.05)。结论中低位直肠癌系膜转移率高,TME应作为手术的基本原则;肿瘤分化程度低、分期晚是系膜环周切缘癌浸润的高危因素,应制定全面的临床治疗方案,合理有效的应用新辅助放化疗和辅助放化疗并密切随访;当肿瘤下缘距齿状线小于3cm时,宜行经腹会阴联合切除术,行经腹超低位前切除术应谨慎。Objective To explore the corelations between mesorectal metastasis and clinicopathologic characteristics of patients with middle and lower rectal cancer,and to provide a histopathologic foundation for the clinical treatment of middle and lower rectal cancer.Methods We analyzed the pathological features of 46 specimens obtained from patients with middle or lower rectal cancer who underwent operation with the principles of TME in our hospital.Results The positive rate of mesorectal metastasis was 67.4%（31/46）;The positive rate of CMI was 21.7%（10/46）,well and moderately differentiated CMI were 10%（1/10）and 14.8%（4/27）respectively,while poorly differentiated CMI was 55.6%（5/9）（P〈0.05）.The positive rates of Dukes B and C CMI were 27.8%（5/18）and 38.5%（5/13）respectively,while Dukes A CMI was 0/15（P〈0.05）;The positive rate of extra low anterior resection DMMI was 60%（3/5）,while abdominoperineal resection DMMI was 0/9（P〈0.05）.Conclusion The positive rate of mesorectal metastasis of middle and lower rectal cancer is significantly high,TME should be followed in the operation of middle and lower rectal cancer;The positive rate of CMI has significant correlation with tumor differentiation and Dukes stage,patients with poor tumor differentiation or Dukes B,C stages should be treated with routine radiotherapy and chemotherapy before and after operation to reduce the possibility of local tumor recurrence;Extra low anterior resection should be applied carefully.

关 键 词：直肠肿瘤/病理学 

分 类 号：R735.37[医药卫生—肿瘤]