直肠癌旁移行粘膜增殖活性及其在保肛手术中的意义

The proliferating ability of transitional mucosa adjacent to rectal carcinoma and its clinical significance in anal sphincter-preserving operation

目的:探讨直肠癌旁移行粘膜(TM)病理学性质及保肛手术肠管切除范围。方法 应用免疫组化及粘液组化方法观察了81例直肠癌及癌旁粘膜的增殖细胞核抗原(PCNA)表达情况及癌旁TM的变化规律。结果:在癌旁TM、非典型增生及癌组织PCNA呈递增表达,与正常粘膜差异非常显著(P<0.01)。癌旁TM范围在粘液癌明显大于乳头状癌及管状腺癌(P<0.01)。癌旁TM范围在粘液癌明显大于乳头状癌及管状腺癌(P<0.01),在Dukes C期明显大于Dukes A、B期(P<0.01、P<0.05)。结论 直肠癌旁TM具有一定的恶性潜势,直肠癌旁TM的范围与直肠癌的类型及进展密切相关。

Objective. To Study the relationship between pathological characteristics of transitional mucosa (TM)adjacent to rectal carcinoma and the resected length of bowel in anal sphincter - presevving operation. Methods. Immunohistochemical and mucin histochemical methods were used in samples of 81 cases of rectal carcinoma. The expression of PCNA and the changing regulations of TM adjacent.to rectal carcinoma were observed. Results. The PCNA expression rate was the highest in cancer and gradually defective in atypical dysplasia,TM and normal mucosa (P<0. 01). The range of TM adjacent to the mucinous carcinoma was more extensive than that to papilla adenoma and tubular adenoma(P<0. 01). The range of TM adajacent to the rectal cancer in Dukes C stage was more extensive than that in stage A. B(P<0. 01.P <0. 05). Conclusions. The TM of rectal carcinoma possessed certain potential of malignancy. The range of TM adjacent to rectal carcinoma was closely related to the pathological type and advancement of rectal carcinoma.