脂肪变性技术处理标本对中低位直肠癌TME术后病理分期的影响

Influence of Managing Specimen with Fat-lucidification Technic on Pathological Staging after TEM for Low and Mid-rectal Carcinoma

为探讨应用脂肪变性技术处理标本对中低位直肠癌全直肠系膜切除（TME）术后病理分期的影响，回顾2006～2011年在杭州市第三人民医院行TME的124例中低位直肠癌患者资料，按术后标本处理方法不同分为研究组和对照组，研究组（46例）应用脂肪变性技术处理标本，对照组（78例）应用福尔马林浸泡法手工处理标本，对比分析两组直肠标本系膜淋巴结检出情况及直肠癌术后病理分期。结果显示，（1）淋巴结检出情况：研究组共检出淋巴结1305枚（28．4枚／例）；检出转移淋巴结167枚（6．0枚／例），其中直径≥5mm的淋巴结91枚，直径〈5mm的淋巴结76枚。对照组共检出淋巴结746枚（9．6枚／例）；检出转移淋巴结99枚（3．5枚／例），其中直径≥5mm的淋巴结90枚，直径〈5mm的淋巴结9枚。研究组检出直肠系膜淋巴结总数及转移淋巴结总数明显多于对照组，P〈0．05；尤其是在直径〈5mm的淋巴结的检出方面研究组明显优于对照组，P〈0．05。（2）术后病理分期：研究组N0（Ⅰ、Ⅱ）期18例，N1（ⅢA）期14例，N2（ⅢB）期14例；对照组N0（I、Ⅱ）期50例，N1（ⅢA）期19例，N2（ⅢB）期9例。研究组N1、N2期直肠癌患者比例明显高于对照组，P〈0．05。结果表明，应用脂肪变性技术处理中低位直肠癌TME术后标本，可有效提高直肠系膜淋巴结特别是直径〈5mm的淋巴结检出率，对准确进行直肠癌病理分期有重要意义。

In order to explore the influence of managing specimen with fat-lucidification technic on patho- logical staging after TME for low and mid-rectal carcinoma author retrospectively analyzed the data of 124 patients with low or mid-rectal carcinoma who had been subjected to TME in the Hangzhou municipal third people＇s hospital from 2006 to 2011 yr. ,according to different management methods for postoperative speci- men,which were divided into study group and control group,compared ＆ analyzed the outcome of detected mesorectal lymph node and postoperative pathological staging of both groups. The specimen of study group （ n =46） had been managed by using fat-lucidification technic,while that of control group（ n =78） manu- ally by using formalin soak method. As results, 1）detection results of lymph node：in study group, the total number of detected lymph nodes was 1305（28.4/case） ,the number of detected metastasis lymph nodes was 167（6.0/case）（among that,91 were in the diameter of ~5mm,76 in GSmm）;in control group,746（9.6/ case） ,99（3.5/case）（90,9）,respectively. It is seen that in first two items study group was significantly more than control group（ P G0.05） ,especially,in the number of detected nodes（G5mm） study group was superior to control group（ P G0.05）;2）on postoperative pathological staging： in study group, No （ Ⅰ , Ⅱ ） stage, 18 cases ; N1 （ⅢA） stage, 14 cases ; N2 （Ⅲ B） stage, 14 cases ; while, in control group, 50,19,9, respec- tively,thus,the ratio of N1, N2 stage patients in study group was significantly higher than that in control group（ P G0.05）. Results show that managing specimen with fat-lucidification technic can effectively en- hance the rate of detected mesorectal lymph nodes,especially small nodes（G5mm）. So that has important significance on accuracy pathological staging for rectal carcinoma.