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目的探讨直肠癌旁移行粘膜 (transitionalmucosa ,TM)的性质及其与术后吻合口癌复发的关系。方法应用组织化学及免疫组织化学技术 ,对 6 7例直肠癌手术切除标本及其近切端肠管(对照组 )与远切端肠管粘膜 ,以及 33例术后 1年 ,31例术后 2年以上直肠粘膜活组织检查标本 (自吻合口至其下 3cm) ,同步检测其p2 1ras与p5 3蛋白表达率 ,增殖细胞核抗原 (PCNA)指数。结果癌组织的TM、p2 1ras与p5 3蛋白表达率及PCNA指数均显著高于近远切端肠管粘膜 (P <0 0 1) ;远切端肠管粘膜除p5 3外的上述指标仍高于近切端肠管 (P <0 0 1) ;术后直肠残端肠管粘膜TM的阳性率 ,在第1、2年均高于近远切端肠管 (P <0 0 1) ;而p2 1ras与PCNA指数均显著低于远切端肠管 ;但p5 3表达率在术后第 1、2年与远切端肠管相比无差异 (P >0 0 5 ) ;直肠远切端肠管粘膜TM无论是阳性或阴性 ,其p2 1ras与p5 3蛋白阳性率及PCNA指数差异均无显著意义 (P >0 0 5 ) ;术后第 1、2年复查吻合口及其以下 1～ 3cm间的直肠粘膜未见癌复发 ;发现TM分布无规律性 ,多出现在粘膜慢性炎症明显区域附近。结论直肠癌旁移行粘膜是一种继发的非特异性改变 ,而不是原发性癌前病变 ,其存在与否和术后吻合口癌复发无关
Objective To investigate the nature of transitional mucosa (TM) adjacent to rectal cancer and its relationship with postoperative recurrence of anastomotic cancers. Methods Tissue chemistry and immunohistochemical technique were used to detect the rectum in 67 cases of resected rectal cancer and the proximal intestine (control group) and distal mucosa of intestine, and 33 cases of postoperative one year, 31 cases of more than 2 years after surgery Mucosa biopsy specimens (from the anastomosis mouth to the next 3cm), simultaneous detection of p2 1ras and p5 3 protein expression rate, proliferating cell nuclear antigen (PCNA) index. Results The expression of TM, p21ras and p53 protein and PCNA index in cancer tissues were significantly higher than those in proximal and distal incision (P <0.01). The above indexes of distal intestinal mucosa besides p5-3 were still higher than that of proximal incision (P <0.01). The positive rate of TM in the rectal stump was higher in the first and second years than that in the distal and distal intestine (P <0.01), while the p21ras and PCNA index were significantly higher (P> 0.05). However, the expression of p5 3 in the first and second year after operation did not show any significant difference (P> 0.05). The intestinal mucosa TM distal to the rectum had positive or negative p21ras (P> 0.05). There was no recurrence of rectal mucosa between the anastomosis and the following 1 ~ 3 cm in the first and second year after operation No regularity, and more in the mucosal obvious area near the chronic inflammation. Conclusion The mucosa adjacent to rectal cancer is a secondary non-specific change, rather than primary precancerous lesions, its presence or absence and recurrence of anastomotic cancers