46例直肠癌远端系膜内扩散情况

Spread of Rectal Cancer in the Distal Mesorectum:A Report of 46 Cases

背景与目的:全直肠系膜切除可能因为清除了直肠癌远端系膜内的转移灶而获得较低的局部复发率,但直肠癌的远端系膜扩散情况如何、应该切除多长系膜才足够等问题尚无定论。本研究的目的是探讨直肠癌远端系膜内扩散的情况,为根治术提供更充分的临床病理证据。方法:应用大切片连续切片、HE染色方法观察46例直肠癌根治术后标本中肿瘤远端扩散的方式和距离,并用Logistic回归方法分析其与临床病理因素的关系。结果:远端肠壁内浸润的发生率为10.9%(5/46),最远距离1.5cm;远端系膜内扩散发生率为21.7%(10/46),最远距离为4cm;扩散的方式有淋巴结转移、孤立的癌结节、脉管和神经浸润。多因素分析显示TNM分期是远端扩散的唯一影响因素。结论:直肠癌远端系膜内扩散较常见,根治术时应切除不少于5cm的远端直肠系膜。

BACKGROUND ＆ OBJECTIVE： Total mesorectum excision （TME） for rectal cancer may reduce local recurrence by complete eradication of metastatic foci in the distal mesorectum. While the spread regulation of rectal cancer in the distal mesorectum and ideal length of mesorectum resection are still unclear. This study was to investigate the spread of rectal cancer in the distal mesorectum. METHODS. The whole-mount section with HE staining was used to detect tumor spread in the mesorectum of 46 rectal cancer patients. The correlation of tumor spread to clinicopathologic parameters was analyzed by Logistic regression. RESULTS. The occurrence rate of distal mural invasion of rectal cancer was 10.9% with the maximal distance of 1.5 cm; that of distal mesorectum spread was 21.7% with the maximal distance of 4.0 cm, which included metastasis in lymph nodes, solitary tumor foci, vessel and perineural invasion. Multivariate analysis showed that TNM stage was the only significant factor influencing distal spread of rectal cancer. CONCLUSIONS. Spread of rectal cancer in the distal mesorectum is common. Resecting at least 5 cm of the mesorectum distal to rectal cancer is recommended.