直肠癌远端扩散的临床病理学研究

Clinical pathological study on distal intramural spread of rectal cancer

目的 探讨直肠癌手术远端肠管长度的安全范围。方法 对 82例直肠癌根治术患者的样本进行多个指标的临床病理学研究。结果 显示肿瘤局部复发远端肠壁内扩散不是主要的 ,而侧方扩散相对重要。结论 导致直肠癌复发的因素较多 ,不宜过分强调远端扩散。对距肛门 5cm左右的低位直肠癌如能争取到肿瘤下方 (1 5～ 2 )cm安全区和肛周 3cm的清除范围 ,保留肛门的直肠前切除应属可行。

Objective To investigate the safe distal surgical resection margin of rectal cancer.Methods Multiple indexes (distal intramural spread and lymph node metastasis) of clinical pathology were studied on 82 cases who were taken radical operation of rectal cancer. Results The distal intramural spread was not the main cause which led to local cancer recurrence, whereas, the lateral intramural spread was relatively important for local cancer recurrence. Conclusion There were many factors which could lead to local cancer recurrence and distal intramural spread should not be over emphasized. Lateral intramural spread should not be ignored. It is reliable to undergo anterior rectal resection with anus reservation if resection margin can extend to 1.5-2cm below the cancer and 3cm above perianus on patients with low rectal cancer whose distance to anus is about 5 cm.