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低位直肠癌病人往往因术后人造肛门的不便而影响生活质量。作者对早期直肠癌病人的临床病理特点进行研究,以阐明内镜治疗的适应证,减少根治手术,提高病人术后生活质量。共观察了早期直肠癌180例,191个病灶中,粘膜癌110个,粘膜下癌81个。所有病灶在1976～1990年经手术或内镜切除。直径11～20mm的病灶中有55%(41/76)、直径>21mm的病灶中有44%(25/57)是粘膜癌。62%(109/169)的高分化腺癌是粘膜癌,95%(21/22)的中度分化腺癌是粘膜下癌。手术治疗的病例中,粘膜癌均无淋巴结转移(0/39),粘膜下癌有9.2%(6/65)发生局部淋巴结转移。总结早期直肠癌的临床病理特点为:(1)病灶越大越易有粘膜下浸润;(2)中度分化腺癌较高分化腺癌容易发生粘膜下和淋巴浸润;(3)粘膜下浸润越大越深,淋巴浸润和淋巴结转移
Low rectal cancer patients often affect the quality of life due to the inconvenience of postoperative artificial anus. The authors studied the clinicopathological features of early rectal cancer patients to clarify the indications for endoscopic treatment, reduce radical surgery, and improve postoperative patient quality of life. A total of 180 cases of early rectal cancer were observed, among 191 lesions, 110 cases of mucosal carcinoma and 81 cases of submucosal carcinoma. All lesions were removed surgically or endoscopically from 1976 to 1990. Of the lesions with a diameter of 11 to 20 mm, 45% (25/57) of lesions with a diameter of >21 mm and 55% (41/76) were mucosal cancers. 62% (109/169) of well-differentiated adenocarcinomas were mucosal cancers, and 95% (21/22) of moderately differentiated adenocarcinomas were submucosal cancers. In the surgically treated cases, there was no lymph node metastasis in the mucosal cancer (0/39), and 9.2% (6/65) of the submucosal cancers had regional lymph node metastasis. The clinicopathological characteristics of early rectal cancer were summarized as follows: (1) The larger the lesions, the more submucosal infiltration; (2) The moderately differentiated adenocarcinomas are more differentiated adenocarcinomas are prone to submucosal and lymphoid infiltration; (3) the submucosal infiltration is more Larger, deeper, lymphoid infiltration and lymph node metastasis