摘要
为探讨大肠癌术后肠粘膜内镜形态改变及增殖力学变化与癌局部复发的关系，对大肠癌外科切除术后１１３例进行内镜随访并分为癌复发组、复发腺瘤组、非复发组三组。应用增殖细胞核抗原（ＰＣＮＡ）、癌基因ｐ５３表达和ＡｇＮＯＲ计数，观察粘膜增殖力学改变。结果显示，内镜下主要表现为水肿、糜烂、结节等病变，形成明显肿块者较少。病理组织学呈炎症改变者６５例，炎性息肉１７例，腺瘤２２例，复发癌９例。非复发组与正常结肠粘膜ＰＣＮＡ标记分别为２８．３２±８．４和３２．４５±８．６（Ｐ＞０．０５）。吻合口出现癌复发时，标记指数达６１．２９±１０．２。ＡｇＮＯＲ计数变化趋势与ＰＣＮＡ标记指数类似。ｐ５３基因在复发癌病变组表达率为２２．２％。因而认为，大肠癌患者非癌变肠粘膜早已存在的细胞动力学异常可能是再发腺瘤和腺癌高发生率的细胞学基础，临床上通过对这些生物标记的观察有助于对大肠癌术后患者进行随访监测。
To evaluate proliferative changes in mucosa of colon at anastomotic site after carcinoma resection and its relationship with local recurrence,113 patients were observed.Moreover,the expression of the proliferating cell nuclear(PCNA)and p53 gene and the counting of silver stained nucleolar organized regions(AgNOR) were studied.It was found that edema(57%),erosion(21%)and nodulation(15%)were the main appearance under endoscopy.Nine(8 0%) recurrent cancers,22(19 5%))adenomas and 82(77 0%)inflammatory lesions were identified by histopatho logy with PCNA labeling index(LI),61 29±10 2 in recurrent cancer;40 10±11 0 in adenoma.LI in non recureent mucosa was slightly higher(32 45±8 6)than that in normal mucosa without cancer(28 32±8 4),though no statistical significance was found.The change of AgNOR counting,which were 1 97±0 41 and 3 55±1 04 in the non reccurent and cancer recurrent anastomatic mucosa,was similar to LI in different lesions.p53 expression was negative in non recurrent mucosa while 22 2% positive in recurrent cancer.It suggested that pre existed abnormality of proliferative kinetics in colon mucosa of patients with cancer be the histological basis for high incidence rate of recurence of cancer and adenoma.It will be helpful by observing of mucosal proliferation to survey and follow up patients after carcinoma resection.
出处
《中华消化内镜杂志》
1997年第2期93-96,共4页
Chinese Journal of Digestive Endoscopy
关键词
大肠肿瘤
手术后
吻合口
粘膜
细胞增殖力学
Coloncancer cancer Anastomosis Recurrence Proliferative kinetics
