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目的探索早期结直肠癌淋巴结转移的规律和相关因素,探讨其治疗方法以及“高级别上皮内瘤变”这一新概念在临床应用中的一些注意事项。方法对复旦大学附属肿瘤医院1985年1月至2000年12月手术治疗的61例黏膜肌层浸润和黏膜下层浸润的早期结直肠癌病例的临床资料进行回顾性分析,并对其中48例行根治性手术的病例选用细胞角蛋白(CK)的单抗、经免疫组化法进行淋巴结微转移的检测。结果黏膜肌层癌变时25%(4/16)的病例可出现区域淋巴结微转移,黏膜下层癌变时则有31.3%(10/32)的病例可出现淋巴结微转移和转移。在黏膜肌层和黏膜下层浸润的早期结直肠癌中,淋巴结微转移的发生和肿瘤大小相关,当肿瘤最大径≥3cm时微转移多见(P=0.031)。黏膜下层浸润时,淋巴结微转移的发生还和癌变的腺瘤类型(绒毛状腺瘤)、浸润深度(sm3)密切相关(P值分别为0.039和0.018)。随访发现11.5%(3/26)的黏膜肌层癌变病例,有局部复发、血道转移等恶性生物学行为表现。结论黏膜肌层浸润的早期结直肠癌病例中已可以出现区域淋巴结的微转移,当癌变浸润至黏膜下层时淋巴结微转移和转移的发生率更高。在早期结直肠癌的治疗中,选择局部切除手术需要慎重。当肿瘤最大径≥3cm、癌变腺瘤为绒毛状腺瘤或有证据提示黏膜下层浸润已达sm3时,建议选择根治性
Objective To explore the rules and related factors of lymph node metastasis in early stage of colorectal cancer and to discuss the treatment methods and some precautions in the clinical application of this new concept of “high grade intraepithelial neoplasia”. Methods The clinical data of 61 cases of early colorectal cancer with mucosal myometrial invasion and submucosal infiltration underwent surgical resection from January 1985 to December 2000 in Cancer Hospital of Fudan University were retrospectively analyzed. Among them, 48 cases were cured Cases of sexual surgery using cytokeratin (CK) monoclonal antibody immunohistochemical detection of lymph node micrometastasis. Results The regional lymph node micrometastasis occurred in 25% (4/16) cases of mucosal myometrial carcinomas, while there was 31.3% (10/32) cases of micrometastasis and metastasis in the submucosal carcinomas. In the early stage of colorectal cancer infiltrating with mucosa and submucosa, the occurrence of lymph node micrometastasis correlated with the tumor size. When the maximum diameter of the tumor was more than 3 cm, micrometastasis was more common (P = 0.031). Submucosal invasion, lymph node micrometastasis and cancerous adenoma type (villous adenoma), depth of invasion (sm3) are closely related (P values were 0.039 and 0.018). Follow-up found that 11.5% (3/26) mucosal myometrial cancer cases, there are local recurrence, hematogenous metastasis and other malignant biological behavior. Conclusion Micrometastasis of regional lymph nodes may occur in the early stage of colorectal cancer with mucosal muscular infiltration. The incidence of lymph node micrometastasis and metastasis is higher when the tumor infiltrates to the submucosa. In the treatment of early colorectal cancer, the choice of partial resection needs careful. When the tumor diameter ≥ 3cm, cancerous adenoma villous adenoma or evidence of submucosal invasion has reached sm3, it is recommended to choose radical