直肠腺癌远端播散的临床意义及癌组织细胞角蛋白的表达

Distal spread of rectal cancer and cytokeratin staining

目的探讨直肠腺癌远端肠壁内和壁外的播散转移差异及远端播散的临床意义.方法收集54例全直肠系膜切除术(TME)后标本,制作直肠全层带系膜大组织切片,行HE染色,显微镜观察病理变化;免疫组织化学染色检测肿瘤组织细胞角蛋白-20.结果远端播散不仅发生在直肠管壁内,还可播散至直肠壁外系膜内脂肪组织,最常见的播散方式为淋巴道弥散;在距肿瘤远端0.5～1.5 cm壁外远端播散与壁内播散有显著性差异;肠壁内远端播散均发生在距肿瘤远端2.0 cm之内,肠壁外远端播散未超过3 cm.远端播散与TNM分期相关,而与肿瘤位置、分化程度无关.54例患者肿瘤组织中细胞角蛋白-20均为阳性表达.结论 TME减少了肿瘤残留及通过远端播散造成复发的可能性.在根治性手术的基础上增加了保留肛门的机率,使部分患者能获得较为满意的排便功能.远端直肠可切除不小于2 cm,系膜不小于5 cm或系膜全切除可以作为保肛手术标准之一.

Objective To study the difference between intramural distal spread and extramural distal spread and significance of distal spread for patients with rectal cancer. Methods Fiftyfour specimens from large slice of rectum and mesorectum meanwhile HE stain and cytokeratin - 20 immunohistochemistry. Results Distal spread happened not only intramural but also extramural. The most model of spread was lymphatic permeation. There was a significance difference between intramural distal spread and extramural distal spread from 0.5 cm to 1.5 cm below the tumor. Distal spread correlated with TNM staging but it didn＇ t correlate with tumor location and differentiation degree. Expression of cytokeratin-20 was positive in tumor tissue in all cases. Conclusion The likelihood of relapsing is dropped due to decreasing of residual and distal spread when TME was taken. The probability of anal sphincter reservation is increased and patients may obtain satisfied function of defecation and uropoiesis. Distal rectum resection longer than 2 cm and DMR resection exceed 5 cm may be one of standard of anal sphincter reservation.