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目的研究直肠癌向直肠系膜远端微转移与临床病理间的关系,为选择直肠癌手术方式提供必要的依据。方法收集46例直肠癌手术后标本,沿肿瘤下缘纵向切取宽约2cm的远端直肠系膜组织,用脂溶法处理后,计数其中淋巴结,随后按每1cm距离切成组织块,行HE染色,取HE检查阴性的切片,再用细胞角蛋白(CK)20为标记的免疫组织化学方法检查,观察显微镜下肿瘤远端直肠系膜中微转移的情况,并进行转移规律分析。结果直肠远端系膜中共检出有淋巴结微转移10例(其中合并有癌结节播散有3例),仅有1例癌结节播散,远端系膜总转移率为23.9%,癌结节微转移率为6.5%,淋巴结微转移率为19.6%;转移最远距离为4cm。直肠癌系膜远端微转移在肿瘤大体类型、浸润深度、分化程度等因素间差异有统计学意义(P<0.05);而在年龄、性别、肿瘤部位和大小等因素间差异无统计学意义(P>0.05)。结论直肠系膜远端的微转移主要表现为淋巴结的微转移和癌结节的形成;转移发生与肿瘤大体类型、浸润深度、分化程度等因素显著相关。
Objective To study the relationship between the distal micrometastasis of rectal cancer and the clinical pathology of rectal cancer and to provide the necessary basis for the selection of surgical methods of rectal cancer. Methods 46 cases of rectal cancer after surgery specimens collected from the lower edge of the tumor along the longitudinal cut 2cm wide distal mesorectal tissue, treated with fat-soluble treatment, counting lymph nodes, and then cut into 1 cm distance into the tissue block, HE staining , Negative sections were taken from HE and then examined by immunohistochemical staining with cytokeratin (CK) 20. The micrometastases in the distal mesocolon of the tumor under microscope were observed and analyzed for metastasis. Results There were 10 cases of micrometastases in the distal rectum (3 cases with cancer nodules combined), only 1 case of cancer nodules disseminated and the total mesangial metastasis rate was 23.9% Cancer nodules micro-metastasis rate was 6.5%, lymph node micrometastasis rate was 19.6%; the most distant transfer of 4cm. The distal micrometastasis of rectum mesothelial cells in the tumor type, depth of invasion, differentiation degree and other factors was statistically significant (P <0.05); but there was no significant difference in age, gender, tumor location and size and other factors (P> 0.05). Conclusion The micrometastases in the distal mesorectum mainly show the micrometastasis of lymph nodes and the formation of cancer nodules. The occurrence of metastasis is closely related to the general type of tumor, the depth of invasion and the degree of differentiation.