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目的评价直肠癌系膜转移与其肿瘤生物学特性的关系。方法选择1997年1月至1998年12月按全直肠系膜切除原则切除的直肠腺癌328例。将直肠周围系膜癌扩散形式划分为三类:直肠系膜结节状癌转移(包括血管旁明显淋巴结转移和系膜脂肪内明显癌结节);直肠系膜非结节状癌转移(微灶样转移)包括:系膜内散在癌细胞积聚、淋巴管静脉内癌栓、末梢小血管和神经浸润、腹膜/肠壁孤立微小种植;直肠系膜癌浸润包括:癌周临近组织脏器浸润、自主神经支干受累、直肠癌环周被膜受累、直肠癌旁脂肪浸润。分析直肠癌系膜转移方式与肿瘤分期、分化、部位的关系。结果直肠系膜结节状转移率为59.8%。直肠系膜非结节状转移率36%,其中单独微灶转移率11.6%。直肠癌环周被膜受累38.1%,其中18例为T2期,直肠癌旁脂肪浸润43.3%,其中26例为T2期。根治术后5年无病生存率总体为63.9%,按TNM分期,T1～3期分别为89.7%、75.7%、52.6%;而按有无直肠癌系膜转移则分别为49.6%和91.4%。结论直肠癌系膜转移形式与恶性肿瘤生物学特点和不良预后密切相关,可作为传统病理分期的补充和术后辅助治疗的选择指标。
Objective To evaluate the relationship between the mesangial metastasis of rectal cancer and its biological characteristics. Methods From January 1997 to December 1998, 328 cases of rectal adenocarcinoma were resected according to the principle of total mesorectal excision. Diffusion of mesorectal cancer around the rectum was divided into three categories: mesenteric nodal nodal metastasis (including lymph node metastasis and mesenteric fat apparent cancerous nodules); mesenteric non-nodular metastasis (microfoci-like) Metastases include: mesangial intramural accumulation of cancer cells, lymphatic vein tumor thrombi, peripheral small blood vessels and nerve infiltration, peritoneal/intestinal wall isolation microimplantation; mesorectal cancer infiltration includes: infiltration of tissue adjacent to the cancer tissue, autonomic nerves Involvement of branches and limbs, involvement of the orbital membrane of the rectal cancer, and fat infiltration around the rectal cancer. Analysis of the relationship between mesangial metastasis and tumor stage, differentiation, and location. Results The mesorectal nodular metastasis rate was 59.8%. The rate of non-nodular metastasis of mesorectum was 36%, of which the metastatic rate of single microsurgery was 11.6%. In the rectal cancer, 38.1% of the peripheral capsules were involved, of which 18 were T2 and 43.3% had paraneoplastic infiltrate, of which 26 were T2. The overall 5-year disease-free survival rate after radical resection was 63.9%. According to the TNM stage, the T1 to 3 stages were 89.7%, 75.7%, and 52.6%, respectively; while those with or without rectal cancer were 49.6% and 91.4%, respectively. . Conclusion The mesenteric metastasis of rectal cancer is closely related to the biological characteristics and poor prognosis of malignant tumors. It can be used as a selection index of traditional pathological staging and postoperative adjuvant therapy.