摘要
目的:探讨低位直肠癌远端肠壁内扩散的距离与方向的关系及其影响因素.方法:沿肿瘤对侧纵行剖开21例低位直肠癌标本的肠管,以肿瘤横径右侧为0°,纵径远端为90°,切取45°、90°、135°等3个方向远端肠壁制作成大切片,比较各个方向壁内扩散距离的差异;比较扩散组(11例)和无扩散组(10例)患者性别、年龄、血癌胚抗原CEA水平、淋巴结转移、大体类型、肿瘤直径、肿瘤占肠腔比例、浸润深度、病理分级及分期差异对直肠癌远端壁内扩散的影响.结果:远端45°、90°、135°方向的扩散发生率分别为33.3%(7/21)、47.6%(10/21)、42.9%(9/21),3者比较,差异无统计学意义(χ2=0.946,P=0.730).远端壁内45°、90°、135°等3个方向扩散的中位距离分别为5.0(3.6~10.0) mm、6.25(5.0~9.0) mm、5.0(3.25~9.25)mm,3者比较,差异无统计学意义(P＞0.05).扩散组和无扩散组患者血CEA水平、肿瘤直径、肿瘤占肠腔比例、浸润深度、病理分期比较,差异有统计学意义(P＜0.05).血CEA水平、肿瘤直径、肿瘤占肠腔比例、浸润深度、病理分期与直肠癌远端壁内扩散存在相关性(P＜0.05).结论:直肠癌向远端肠壁内3个方向扩散的距离无明显差异,传统2 cm远端安全切缘同样适合于45°、135°方向.血CEA、肿瘤直径、肿瘤占肠腔比例、浸润深度、病理分期是直肠癌远端壁内扩散的影响因素.
Abstract
Objective:To study the relationship between the distance and direction of distal intramural spread of low rectal cancer and the influencing factors.Methods: Intestinal specimens derived from 21 patients were subject to incision longitudinally, with the right portion of the transverse diameter being taken as 0° and the longitudinal diameter as 90°, This was followed by preparation of the distal rectal wall tissue at 45°, 90° and 135° for comparison on the differences of distances among three directions. The differences in gender, age, blood carcinoembrionic antigen (CEA), lymph node metastasis, tumor macroscopic classification, diameter of tumor, the ratio of tumor to rectal circumference, depth of invasion, as well as effects of differentiation and pathological stage on distal intramural spread were compared between metastasis group (n=11) and nil metastasis group (n=10). Results: The rate of distal metastasis was 33.3% (7/21), 47.6% (10/21) and 42.9% (9/21) at 45°, 90° and 135°, respectively (χ2=0.946, P=0.730). The median distances was 5.0(3.6~10)mm, 6.25(5.0~9.0)mm and 5.0(3.25~9.25)mm at 45°, 90° and 135°, respectively (P>0.05). Compared with nil metastasis group, the metastasis group yielded significant differences in blood CEA, diameter of tumor, the ratio of tumor to rectal circumference, depth of invasion and pathological stage (all P<0.05). There was a statistically significant correlation among gender, age, lymph node metastasis, tumor macroscopic classification and differentiation (all P<0.05). Conclusion: The distances between three directions of distal intramural spread of rectal cancers are not significantly different. The traditional 2cm margin is equally feasible for 45°and 135° incisions. The blood CEA, diameter of tumor, the ratio of tumor to rectal circumference, depth of invasion and pathological stage are the factors influencing distal intramural spread of rectal cancers.
NETL
NSTL
维普
万方数据