摘要
目的:研究中低位直肠癌系膜环周切缘癌浸润的存在规律,为直肠癌的临床治疗提供病理学依据。方法:随机选取2006年11月至2007年7月期间中低位直肠癌患者41例,均以全系膜切除(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环周切缘癌浸润的情况。结果:HE染色病理大组织切片检测中下段直肠癌系膜环周切缘癌浸润阳性率为21.95%(9/41)。高、中分化肿瘤系膜环周切缘癌浸润阳性率分别为16.67%(1/6)、8.00%(2/25),低分化肿瘤阳性率高达60.00%(6/10)(P<0.05)。肿瘤下缘距齿线距离<5cm的系膜环周切缘癌浸润阳性率46.15%(6/13),高于≥5cm的阳性率10.71%(3/28)(P<0.05)。患者性别、年龄、肿瘤大体类型、浸润深度、淋巴结转移情况、手术方法(开腹/腹腔镜)均与系膜环周切缘癌浸润阳性率无明显相关性(P>0.05)。结论:病理大组织切片能客观准确地观察直肠癌术后系膜环周切缘癌浸润情况,术后应常规进行该项检查。肿瘤分化程度低、肿瘤位置低是系膜环周切缘癌浸润存在的高危因素。对于存在系膜环周切缘癌浸润的患者,术后应行规范的放化疗。
Objective：To evaluate the characteristics of circumferential margin infiltration in middle and （or） lower rectal cancer, to investigate the pathological basis for the prognosis of rectal cancer, to validate circumferential margin involvement （CMI） as a very important factor in reducing postoperative recurrence, and to provide a theoretical foundation for the selection of specific parameters for clinical diagnosis and treatment of rectal cancer. Methods： We analyzed the pathological features of 41 tissue samples obtained from patients with middle or lower rectal cancer who underwent surgery with the principles of total mesorectal excision （TME） during November 2006 and July 2007. Results： The positive rate of CMI was 21.95% （9/41）. The positive rates of moderately and well differentiated CMI were 16.67% （1/6） and 8% （2/25）, respectively, while the positive rate of poorly differentiated infiltration was 60% （6/10） （P〈0.05）. The positive rate of CMI was lower in moderately and well differentiated groups than in the poorly differentiated group. The positive rate of CMI was 46.15% （6/ 13） in the specimens whose lower edge was less than 5 cm to the dentate line and 10.71% （3/28） in the specimens whose lower edge was not less than 5 cm, with a significant difference （P〈0.05）. No significant correlation was found between circumferential resection margin and other clinicopathologic features such as gender, age, tumor infiltration, lymph node metastasis, pathological type or surgical method （P〉0.05）. Conclusion： Circumferential margin infiltration in patients with rectal cancer can be observed in pathological large slices. Pathological large slices can help accurately identify the TNM stage of rectal cancer and select corresponding clinical treatment. Examination of pathological large slices should be a routine procedure after surgery for patients with rectal cancer. Patients with circumferential margin infiltration should be treated with routine radiotherapy and chemotherapy after surgery to reduce the possibility of local tumor recurrence.
出处
《中国肿瘤临床》
CAS
CSCD
北大核心
2008年第22期1265-1268,共4页
Chinese Journal of Clinical Oncology
基金
河北省普通高校强势特色学科建设基金资助(编号:(2005)52)
关键词
直肠癌
术后环周切缘环周切缘癌浸润
病理大组织切片
Rectal cancer
Circumferential resection margin
Circumferential margin involvement
Pathological large slice
