低位直肠癌远侧端壁内逆行浸润的适形特点研究

Study on the Pathological Conformal Characteristic of Distal Intramural Spread of Low Rectal Cancer

目的探讨低位直肠癌向远侧端肠壁浸润的病理学特点。方法对36例低位直肠癌患者手术标本在病灶同侧及对侧分别取材行病理检查。19例患者肿瘤占肠腔>1/2周标本仅行同侧取材,以肿瘤为中心从肿瘤下缘正前方、正斜方及过肿瘤中心两侧正横向3个方向等距离多位点取材。17例患者肿瘤浸润肠腔≤1/2周标本行同侧取材外再对侧取材,根据肿瘤下缘与齿线之间距离不同取材方法不同,距离≤2cm者自肿瘤下缘水平面对侧直肠壁开始取材至齿线下2cm,距离>2cm者自肿瘤下缘水平面对侧直肠壁开始取材至齿线下1cm。结果低位直肠癌向远端肠壁浸润距肿瘤下缘<3cm,斜向横向浸润距肿瘤<1.0cm,肿瘤浸润肠腔>1/2周、低分化患者向直肠壁远侧端浸润距离更远。肿瘤浸润肠腔≤1/2周标本同侧肠壁浸润距肿瘤下缘<1cm,肿瘤下缘水平面对侧直肠壁至齿状线直肠壁均未见肿瘤细胞浸润。结论肿瘤浸润肠腔≤1/2周、中高分化且未累及齿线的低位直肠癌壁内浸润具有适形特点,在保持TME原则的前提下对低位直肠癌远侧端肠壁采用适形切除保肛方法可能会保留更好的肛门直肠功能。

Objective To investigate the pathological characteristic of distal intramural spread（DIS） of low rectal cancer. Methods Thirtysix specimens with low rectal cancer were examined in the pathological study. Nineteen specimens with tumor diameter 〉 1/2 circ- umference were pathologically removed organ blocks in three various directions （the front, oblique and lateral directions） in lesion side and sectioned for pathological examination. Seventeen specimens with tumor diameter≤ 1/2 circumference were pathologically removed organ blocks in the contralateral side and sectioned for pathological examination in addition to the lesion side, tissue drawing was ended at 2cm down the detate lines if the distance between tumor and detate lines was less than 2cm,but tissue drawing was ended at lcm down the de- tate lines if the distance between the tumor and the detate lines was more than 2cm. Results The length of DIS of low rectal cancer was less than 3cm in front direction, but the length of DIS in oblique and lateral directions were less than 1. Ocm. The tumor invaded more far- ther in the specimens with poor differentiation,tumor diameter 〉 1/2 circumference. The length of DIS of low rectal cancer was less than lcm in front direction and the rectal wall in the cotralaterl side was not invaded in the specimens with tumor diameter ≤1/2 circumfer- ence. Conclusion The conformal characteristic of DIS of low rectal cancer was observed in the specimens with tumor diameter ≤ 1/2 circumference, high - moderate differentiation and the detate lines was not invaded. The better anal function maybe be reserved if the con- formal resection can be used in low rectal cancer according to TME principle.