应用流式细胞技术及病理检测对直肠癌手术切除范围的再探讨

Reevaluation resection margin rectal cancer by flow cytometry and pathological examination

目的探讨直肠癌根治术合理的手术范围。方法应用病理检测和流式细胞技术，对30例直肠癌全直肠系膜切除术标本进行分析，观察直肠癌组织和癌远端3cm和5cm、正常肠管组织和癌旁3cm和5cm直肠系膜及正常结肠系膜组织的DNA倍体、DNA指数（DI）、增殖指数（PI）和增殖期细胞百分比（SPF）值的变化，并与病理检测相对照。结果病理检测结果显示：直肠癌远端3cm和5cm肠管中均未检测到癌浸润．而癌旁3cm和5cm直肠系膜癌转移率分别为26．7％和6．7％。流式细胞技术检测结果显示：癌组织的DI、P1和SPF值显著高于癌远端3cm和5cm及正常肠管组织，癌远端3cm肠管组织也显著高于癌远端5cm及正常肠管组织，而癌远端5cm肠管与正常肠管比较，差异无统计学意义（P〉0．05）。癌组织细胞异倍体率与癌远端3cm肠管比较，差异无统计学意义（P〉0．05）；而显著高于癌远端5cm及正常肠管组织。癌组织的DI和异倍体率与癌旁3cm和5cm直肠系膜组织相比，差异无统计学意义．但显著高于正常系膜，而癌旁3cm和5cm直肠系膜组织的DI和异倍体率亦显著高于正常系膜。癌组织P1和SPF则显著高于癌旁3cm和5cm及正常系膜。结论病理学分析结果显示．直肠癌远端3cm肠管组织为安全组织；而流式细胞学分析结果显示．直肠癌远端3cm肠管组织和癌旁5cm直肠系膜为不安全组织；手术切除范围应达癌远端系膜5cm以上。

Objective To investigate the appropriate distal resection margin in rectal cancer patients. Methods Thirty specimens of rectal carcinoma with total mesorectal excision （TME） were studied by flow cytometry and pathological examination. The differences of DNA ploidy status, DNA index （DI）, proliferative index （PI）, S-phase fraction （SPF） among rectal cancer, 3 cm and 5 cm below the tumor, normal rectum, distal mesorectum 3 cm and 5 cm below the tumor, and normal colon mesentery were analysed by flow cytometry, and were compared with the data of pathological examination. Results Pathological examination showed that there was no tumor invasion 3 cm and 5 cm below the tumor, but the metastasis rates of distal mesorectum 3 cm and 5 cm below the tumor were 26.7% and 6.7% respectively. The DI, PI and SPF of rectal cancer by flow cytometric examination were significantly higher than those of distal rectum 3 cm and 5 cm below the tumor, and normal rectum （P 〈 0.05）. The DI, PI and SPF of distal rectum 3 cm below the tumor were also significantly higher than those of distal rectum 5 cm below the tumor, and normal rectum（P 〈 0.05）, but there were no significant differences between DI, PI and SPF of distal rectum 5 cm below the tumor and those of normal rectum （P 〉 0.05）. The rate of DNA aneuploid of tumor was significantly higher than those of normal rectum and distal rectum 5 cm below the tumor,but there was no significant difference between the rate of DNA aneuploid of tumor and that of distal rectum 3 cm below the tumor. The DI and DNA aneuploid of rectal cancer and distal mesorectum 3 cm and 5 cm below the tumor were significantly higher than those of normal mesorectum,but there were no significant differences between DI and DNA aneuploid of rectal cancer and those of distal mesorectum 3 cm and 5 cm below the tumor. The PI and SPF of rectal cancer were significantly higher than those of normal mesorectum and distal mesorectum 3 cm and 5 cm below the tumor. Conclusions Rectal cancer is able to invade distal rectum 3 cm below the tumor and distal mesorectum 5 cm below the tumor, and radical resection of rectal cancer should beyond that range.