低位直肠癌壁内逆行浸润的病理学研究

The Clinicopathological Observation on Downward Invasion along Rectal Wall of Low Rectal Carcinoma

目的 了解低位直肠癌肠壁内逆行浸润规律。方法 对 77例低位直肠癌术后标本远端壁内浸润进行病理学观察。结果 Dukes A、 B期 5 7例 ,肿瘤向下浸润未超过 1cm5 5例 (96 .5 % ) ,无 1例向下浸润超过 3cm;高中分化腺癌 5 9例 ,肿瘤向下浸润未超过 1cm5 6例 (94.9% ) ,无 1例向下浸润超过 3cm;肉眼观察隆起型 6 1例 ,肿瘤向下浸润在 1cm以内5 7例 (93.4% ) ,无 1例向下浸润超过 3cm;癌瘤侵犯直肠直径 <0 .5 cm的 5 4例 ,肿瘤向下浸润在 1cm以内 5 2例 (96 .3% ) ,亦无 1例向下浸润超过 3cm。本组肿瘤向下浸润超过 3cm2例 ,均为病期晚 ,病理分化程度差 ,肉眼观为浸润型的病例。结论 低位直肠癌病期较早者、病理分化程度较好者、肉眼观为隆起型者、癌瘤侵犯直肠周经 <1/ 2者 ,其肠壁内逆行浸润绝大部分不会超过 1cm,一般不会超过 3cm。其保肛手术 ,下切缘 3cm已属安全。

Objective To study the rule of distal intraparietal invasion of low rectal carcinoma Methods The distal parts of rectum from 77 cases with low rectal carcinoma were examined histopathologically Results Among the 57 cases classified as Dukes A or Dukes B,55(96 5%)showed no distal invasion beyond 1cm,and there was not even one case that invaded distally beyond 3cm Among the 59 cases of high or moderate differentiated adenocarcinomas,56(94 9%)showed no distal invasion beyond 1cm, no one invaded farther than 3cm Among 61 cases of protruding shape,57 (93 4%)invaded distally within 1cm,no one invaded farther than 3cm Among 54 cases that the carcinoma invaded less than 1/2 of the rectal circumference, 52(96 3%)invaded distally not farther than l cm,no one invaded downoards farther than 3cm There were only 2 cases in all of the samples that invaded distally more than 3cm Both were advanced,low differentiated and belong to the infiltrating type Conclusions Most of the low rectal carcinoma cases that are in early stage,well differentiated,protruding shaped and invade less than 1/2 of the rectal circumference,mostly did not invade downwards farther than l cm,and generally no farther than 3cm,The incision matgin during anus preserved operation below 3 cm of rectal carcinoma is within safe side