直肠癌旁移行粘膜病理变化的动态观察与临床意义  

The pathological change in transitional mucosa adjacent to the rectal cancer and its clinical significance

作　　者：池畔[1] 胡天明[1] 陈大良[1] 殷凤峙[1] 

机构地区：[1]福建医科大学附属协和医院普外科大肠癌专业组,福州350001

出　　处：《中华普通外科杂志》2002年第2期83-85,共3页Chinese Journal of General Surgery

摘　　要：目的探讨直肠癌旁移行粘膜 (transitionalmucosa ,TM)的性质及其与术后吻合口癌复发的关系。方法应用组织化学及免疫组织化学技术 ,对 6 7例直肠癌手术切除标本及其近切端肠管(对照组 )与远切端肠管粘膜 ,以及 33例术后 1年 ,31例术后 2年以上直肠粘膜活组织检查标本 (自吻合口至其下 3cm) ,同步检测其p2 1ras与p5 3蛋白表达率 ,增殖细胞核抗原 (PCNA)指数。结果癌组织的TM、p2 1ras与p5 3蛋白表达率及PCNA指数均显著高于近远切端肠管粘膜 (P <0 0 1) ;远切端肠管粘膜除p5 3外的上述指标仍高于近切端肠管 (P <0 0 1) ;术后直肠残端肠管粘膜TM的阳性率 ,在第1、2年均高于近远切端肠管 (P <0 0 1) ;而p2 1ras与PCNA指数均显著低于远切端肠管 ;但p5 3表达率在术后第 1、2年与远切端肠管相比无差异 (P >0 0 5 ) ;直肠远切端肠管粘膜TM无论是阳性或阴性 ,其p2 1ras与p5 3蛋白阳性率及PCNA指数差异均无显著意义 (P >0 0 5 ) ;术后第 1、2年复查吻合口及其以下 1～ 3cm间的直肠粘膜未见癌复发 ;发现TM分布无规律性 ,多出现在粘膜慢性炎症明显区域附近。结论直肠癌旁移行粘膜是一种继发的非特异性改变 ,而不是原发性癌前病变 。Objective To investigate the biopathologic characteristics of transitional mucosa (TM) adjacent to rectal cancer and its relationship to the anastomotic recurrence after curative surgery of rectal cancer. Method The expression of p53,p21 ras and PCNA proteins was determined immunohistochemically in primary rectal adenocarcinomas (n=67), the proximal margins (n=67), the distal margins (n=67) and rectal mucosa 1～3?cm distant to the anastomosis in patients one year after radical resection (n=33), and two years after (n=31).Results The expression of TM, p21 ras and p53 proteins,and PCNA index in primary rectal adenocarcinomas was higher than that in two resection margins (P<0.01). The other values except for p53 in distal margins were higher than that in proximal margins (P<0.01). The expression of TM in stump rectum after surgical resection was higher than that in both resection margins (P<0.01), while p21 ras and PCNA index were lower in proximal than in distal margins (P<0.05), but the expression of p53 protein in the mucosa was similar between that after surgery and that of distal margins (P<0.05). The expression rates of p21 ras,p53 proteins and PCNA index were similar between TM positive and TM negative group (P>0.05). Positive TM was often found in the area of chronic inflammation. conclusion TM adjacent to the rectal cancer is a nonspecific, not cancer precursor event.

关 键 词：直肠肿瘤 粘膜病理 局部肿瘤复发 

分 类 号：R735.37[医药卫生—肿瘤]