直肠癌远侧直肠系膜微转移的临床病理学研究

Relationship between clinicopathology and micrometastasis of rectal carcinoma in distal mesorectum of rectaum

目的研究直肠癌向直肠系膜远端微转移与临床病理间的关系,为直肠癌手术方式提供依据。方法收集直肠癌术后标本42例,沿肿瘤下缘纵向切取宽约2cm的远端直肠系膜组织,用脂溶法处理后,计数其中淋巴结,随后按每1cm距离切成组织块,行HE染色,取HE检查阴性的切片,再用细胞角蛋白(cytokeratin,CK)20为标记的免疫组织化学方法检查,观察肿瘤远端直肠系膜中微转移的情况。结果直肠远端系膜中共检出8例有淋巴结微转移(其中2例合并有癌结节播散),1例仅有癌结节播散,远端系膜总转移率为21.43%(9/42);转移最远距离为4cm。直肠癌系膜远端微转移在肿瘤大体类型、分化程度、浸润深度等因素间差异有统计学意义(P<0.05);而在年龄、性别、肿瘤部位和大小等因素间差异无统计学意义(P>0.05)。结论直肠系膜远端的微转移主要表现为淋巴结的微转移和癌结节的形成;微转移发生与肿瘤大体类型、分化程度、浸润深度等因素显著相关。

Objective To study the relationship between the clinicopathology and the rnicrometastases of rectal carcinoma in distal mesorectum, and to provide evidence for rectal carcinoma operations. Methods A total of 42 patients with rectal carcinoma were enrolled. The specimens were collected from the distal end of the tumor toward the anus, a piece of 2 cm tissue of the distal rectal mesorecturn was cut and the lymph nodes were counted in distal mosorectum after treatment by the fat clearing method. The tissues were cut further into as small as 1 cm of each piece and hematoxylin-eosin（HE） staining was carried for the tissues. For those specimens negative for HE staining the cytokeratin 20 was examined by using immunohistochemistry to observe the micrometastases of carcinoma in distal ＇rectal mesorectum. Results The metastasis rate of tumor was 21.43 %（9/42） and the range of spread to the distal mesorectum was within 4 cm in which eight of the cases had micrometastasis in distal mesorectum and one only had cancer node. Two patients of them were found having both micrometastases and cancer node in distal mesorectum. Conclusion The micrometastases of rectal carcinoma in distal mesorectum include the micrometastasis to lymph node and cancer node;The micrometastasis in distal mesorectum of rectum was correlated significantly with histological type, invasive depth and differential degrees.