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目的探讨直肠腺癌远端肠壁内和壁外的播散转移差异及远端播散的临床意义。方法收集54例全直肠系膜切除术(TME)后标本,制作直肠全层带系膜大组织切片,行HE染色,显微镜观察病理变化;免疫组织化学染色检测肿瘤组织细胞角蛋白-20。结果远端播散不仅发生在直肠管壁内,还可播散至直肠壁外系膜内脂肪组织,最常见的播散方式为淋巴道弥散;在距肿瘤远端0.5~1.5 cm壁外远端播散与壁内播散有显著性差异;肠壁内远端播散均发生在距肿瘤远端2.0 cm之内,肠壁外远端播散未超过3 cm。远端播散与TNM分期相关,而与肿瘤位置、分化程度无关。54例患者肿瘤组织中细胞角蛋白-20均为阳性表达。结论TME减少了肿瘤残留及通过远端播散造成复发的可能性。在根治性手术的基础上增加了保留肛门的机率,使部分患者能获得较为满意的排便功能。远端直肠可切除不小于2 cm,系膜不小于5 cm或系膜全切除可以作为保肛手术标准之一。
Objective To investigate the difference of disseminated metastasis in distal rectal wall of rectal adenocarcinoma and the clinical significance of distal dissemination. Methods Totally 54 specimens of total mesorectal excision (TME) were collected to make large section of mesorectal mesangial tissue. HE staining was used to observe the pathological changes by microscope. The cytokeratin-20 was detected by immunohistochemical staining. The results of distal dissemination not only occurred in the wall of the rectum, but also disseminated to the rectal wall outside the mesangial adipose tissue, the most common mode of dissemination of lymphatic spread; distal 0.5 to 1.5 cm away from the wall of the wall There was a significant difference between the distal and distal disseminations. The distal and distal dissections in the intestinal wall occurred within 2.0 cm away from the distal end of the tumor, and the distal spread outside the intestinal wall did not exceed 3 cm. Distal dissemination and TNM staging related, but not with the tumor location, the degree of differentiation. 54 cases of tumor tissue cytokeratin-20 were positive. Conclusion TME reduces the possibility of tumor recurrence and recurrence by distal dissemination. On the basis of radical surgery to increase the chance of retaining the anus, so that some patients can get more satisfactory bowel function. The distal rectum resectable not less than 2 cm, mesangial not less than 5 cm or mesangial total resection can be used as one of the standard anus surgery.