290例大肠癌的临床病理研究

A clinicopathologic study of 290 cases with large bowel cancer

目的:分析大肠癌标本的肉眼检查和切缘镜检对大肠癌预后的意义。方法:对290例肠癌切除标本的肉眼和镜检,包括肿块大小,肿块与切缘的距离,切缘是否癌浸润,淋巴结是否转移,术后2年有无局部复发。结果:发现切缘镜检癌浸润者占2.75％,而4例血管内癌栓者无局部浸润,35例切缘镜检无癌者术后2年内局部复发,复发率为25.7％。结论:对肿块与切缘距离少于3cm者镜检即足以检出肿瘤局部浸润,局部复发的主要原因可能是术中血行播散,淋巴结清扫比切除肠管长度更重要,血行播散不能忽视。

Purpose:To analyse the difference between the microscopical examination on the resection margins and routine vi-sual examination of large bowel cancer. Methods: The routine and microscopical examination was studied in 290 cases of large bowel cancer,including tumor area、the distance between tumor and the resection margin、lymphonode metastasis、recrudesce or not(2 years after operation). Results:2. 75% of the cases were cancer cells invasion in resection margin with microscopical exami-nation. 4 cases with vascular cancer mass but without invasion on margins. 35 cases local recrudescence in two years but no inva-sion, relapses rate was 25. 7%. Conclusions:Microscopical examination on the cases with that distance less than 3 cm between tu-mor and resection margin is important to find cancer invasion. The main reason for local recurrence may be blood transmissive cancer cells during bowel cancer surgical operation. Lymphonodes remove is more important than the resection length. Blood steam cancer cell migration should not be neglected.