直肠癌远端肠管、直肠系膜内DNA含量的检测及其临床意义

Detection of DNA content in the distal bowel and mesorectum of rectal carcinoma and its clinical significance

目的 检测直肠癌组织中DNA含量、细胞增殖活性并以此探讨直肠癌远端肠管及直肠系膜的切除范围。方法 应用流式细胞术对 38例直肠癌手术标本的癌组织、远端 3cm、5cm处肠管及相应的 3～ 5cm、>5cm处直肠系膜和正常组织中DNA指数 (DI)增殖指数 (PI)和S期细胞百分比 (SPF)进行检测 ,并比较各组织间差异。结果 癌组织、癌远端 3cm肠管中异倍体率显著高于癌远端 5cm肠管及正常组织 (P <0 .0 5 ) ,癌远端 3cm肠管与癌组织、癌远端 5cm肠管与正常组织间异倍体率无显著差异。癌组织中PI及SPF显著高于癌远端 3cm、5cm肠管及相应直肠系膜和正常组织 (P <0 .0 5 )。癌远端 3cm、5cm肠管中PI及SPF高于正常组织 ,但差异无显著性 (P >0 .0 5 )。癌组织、癌远端 3～ 5cm、>5cm处直肠系膜中异倍体率及PI、SPF值均显著高于正常组织 (P <0 .0 5 ) ;远端直肠系膜中异倍体率高于癌组织 ,但无显著差异 ;不同范围内的远端系膜中异倍体率、PI及SPF无显著差异 (P >0 .0 5 )。结论 直肠癌远端 3cm肠管中存在着DNA含量及细胞增殖活性的异常改变 ,具有恶变倾向 ,手术时应予以切除。直肠癌远端 3～ 5cm、>5cm处直肠系膜中也存在着DNA含量及细胞增殖活性的异常改变 ,呈现出恶性肿瘤生物学特性 。

Objective To explore the optimal extent of resectiou of distal rectum and mesorectum by detection DNA contents.Methods Thirty eight cases of rectal carcinoma,distal rectuw 3cm and 5cm away from tumor margin,distal mesorctum 3-5cm and >5cm below the tumor and 10 cases of normal tissue DNA index (DI),proliferation index (PI) and S-phase fraction (SPF) were detected by the flow cytometry.Results The aneuploidy rate in tumor and 3cm distal bowel were significantly higher than those in 5cm distal rectum and normal tissue( P <0.05).No significant difference of aneuploidy rate was found neither in tumor and 3cm distal bowel,nor in normal tissue and 5cm distal bowel.The PI and SPF in tumor were significantly higher than those in 3cm, 5cm distal bowel and normal tissue( P <0.05).However,compared 3cm of 5cm distal bowel with normal tissue there was no significant difference in any case.The aneuploidy rate,PI and SPF in tumor and distal mesorectum (3-5cm and >5cm below tumor) were significantly higher than these in normal mesocolon.The aneuploidy rate in distal mesorectum was also higher than that in tumor,but there was no significant differences.No difference of aneupoidy rate,PI and SPF were found between 3-5cm and >5cm distal mesorectum.Conclusion The abnormal alters of DNA contents and cell proliferative activity have existed in the 3cm distal rectum they have possessed the tendency of malignancy should be removed in curative procedure for rectal carcinoma.These changes existed in the 3-5cm and >5cm distal mesorctum,It is necessory to perform>5 cm distal mesorectal excision in the surgical management of rectal cancer.