摘要
背景超低位直肠癌保持环周切缘完整性的精确解剖层面及其病理学意义尚未明确。本文探究括约肌间复合体的空间结构及其在超低位直肠癌经括约肌间切除术中的临床意义。材料与方法由应用外科解剖学实验室提供福尔马林固定半骨盆标本(n=37),通过大体解剖和多重免疫荧光技术分析括约肌间复合体的解剖学特征。前瞻性纳入2019—2024年接受腹腔镜全直肠系膜切除术联合经括约肌间切除术的221例超低位直肠癌患者。主要终点包括无病生存期、局部无复发生存期和总生存期,次要终点是肛门直肠功能。结果解剖学与组织学研究提出了括约肌间复合体的概念。在括约肌间复合体中发生肿瘤转移的比例为61/197(30.96%),表明括约肌间复合体是超低位直肠癌的潜在转移部位。相比不完全切除括约肌间复合体与非括约肌间复合体切除,完全切除括约肌间复合体与更优的无病生存期【HR,0.382(95%CI:0.187~0.781);P=0.008】和局部无复发生存期【HR,0.251(95%CI:0.085~0.741);P=0.012】显著相关,且三组间Wexner评分与低位前切除综合征评分无显著差异。结论对括约肌间复合体的系统性解剖分析明确了超低位直肠癌手术关键结构。括约肌间复合体常为肿瘤转移部位,完全切除括约肌间复合体可为超低位直肠癌患者带来良好预后。
Background The precise anatomical plane and the pathological significance of circumferential resection margin integrity for ultralow rectal cancer remain inadequately defined.This article investigates the spatial architecture of the intersphincteric complex(ISC)and its clinical implications in intersphincteric space dissection for ultra-low rectal cancer.Materials and methods Formalin-fixed hemipelvis specimens(n=37)from the laboratory of applied surgical anatomy were analyzed by macroscopic dissection and multiplexed immunofluorescence to characterize anatomical features of the ISC.Additionally,patients diagnosed with ultra-low rectal cancer(n=221)between 2019 and 2024 were enrolled prospectively.Primary endpoints for the patient group included disease free survival,local recurrence free survival and overall survival.Secondary endpoints involved the assessment of anorectal function using prospective questionnaires.Results Anatomy and histologic research introduced the concept of the intersphincteric complex.Proportion of patients with tumor metastasis in the intersphincteric complex was 61/197(30.96%),indicating that the intersphincteric complex represented a potential site for metastasis in ultra-low rectal cancer.Complete intersphincteric complex excision was associated with favorable disease-free survival(HR,0.382[95%CI,0.187-0.781];P=0.008)and local recurrence-free survival(HR,0.251[95%CI,0.085-0.741];P=0.012)in patients and no significant differences was found among three subgroups concerning Wexner scores and LARS scores.Conclusion A systematic anatomical analysis of the intersphincteric complex clearly elucidated key structures facilitating for ultralow rectal cancer.The intersphincteric complex is frequently a site for tumor metastasis and complete intersphincteric complex excision conferring favorable prognosis in patients with ultralow rectal cancer.
作者
贾俊杰
孙凌宇
Jia Junjie;Sun Lingyu
出处
《结直肠肛门外科》
2025年第5期447-448,共2页
Journal of Colorectal & Anal Surgery
