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目的研究低位直肠癌在直肠系膜各区域微转移的分布规律,为直肠癌最佳手术方案的制定提供病理学依据。方法 62例经低前切除和全直肠系膜切除术的患者,其手术标本经取材、包埋后,以2．5 mm的间隔行大组织切片,切片行HE染色。在大组织切片上直肠系膜被分为3个区域:直肠系膜外侧区、直肠系膜中间区、直肠系膜内侧区。通过显微镜在切片上观察直肠癌微转移灶的区域分布、发生频率、类型、是否淋巴转移以及与肿瘤原发灶的关系。结果直肠癌微转移灶发生在直肠系膜和直肠系膜外侧区的频率分别为38．7％(24／62)和25．8％(16／62)。微转移灶侵犯标本环周切缘和远端直肠系膜的频率均为6．5％(4／62),远端直肠系膜的转移不超过肿瘤下缘以远3 cm。大多数直肠系膜内有微转移的患者(20／24),其临床病理分期为Dukes c。结论低位直肠癌手术时,完整地切除直肠系膜而不破坏其外侧区至关重要;本研究的结果支持远端直肠系膜的切除长度不能<4 cm的临床原则。
Objective To study the distribution of micrometastases in low rectal cancer in various regions of the rectum and to provide a pathological basis for the development of optimal surgical protocols for rectal cancer. Methods Sixty-two patients undergoing low anterior resection and total mesorectal excision were enrolled. The surgical specimens were harvested and embedded. Large sections of tissue were cut at intervals of 2.5 mm. HE staining was performed on the sections. The mesorectum is divided into three regions on the large section of the tissue: the mesial mesorectum, the mesorectum middle region, and the mesorectum medial region. The distribution of micrometastases, the frequency, type, lymph node metastasis and the relationship with the primary tumor were observed microscopically. Results The frequency of micrometastases in rectal cancer was 38.7% (24/62) and 25.8% (16/62) in the mesorectum and rectum, respectively. Micrometastasis invaded specimens around the margins and the distal mesorectal membrane frequency was 6.5% (4/62), distal mesorectal metastasis does not exceed the lower edge of the tumor 3 cm. Most patients with micrometastases in the mesorectum (20/24) have a clinicopathologic stage of Dukes c. Conclusions In low rectal cancer surgery, complete resection of the mesorectal membrane without destroying the lateral region is crucial. The results of this study support the clinical principle that the distal mesorectal excision length can not be <4 cm.