直肠癌大组织切片系膜九分区法病理学研究

目的　探索直肠癌全直肠系膜切除术 (TME)的必要性和选择性全直肠系膜切除术(STME)的最佳切除范围。方法　以 31例直肠癌TME手术标本为对象 ,纵向由远及近以 5mm的间距连续取材 ,常规固定包埋 ,大组织切片机以 2 .5cm的间隔连续切片 ,HE染色 ,光学显微镜观察结果。将直肠系膜等分为内、中、外三个带 ,每带按左、右、后三个方向分为三个区 ,直肠癌在直肠系膜内的转移灶分别定位于上述九个区。结果　直肠系膜外带内癌转移 1 4例 (4 5 .2 % ) ,全部为低位直肠癌 ;远端直肠系膜 (DMR)内癌转移 2例 (6 .5 % ) ,均在原发灶下缘以远 3.0cm以内 ;环周切缘癌浸润 2例 (6 .5 % )。结论　低位直肠癌根治手术时 ,完整地切除直肠系膜非常必要 ;远端直肠系膜的切除应达到肿瘤下缘以远 4cm。

Pathologic study on rectal cancer with whole-mount section technique and mesorectal nine-regional method

Objective To study the necessity of total mesorectal excision(TME)and optimal length of resection margin of selected total mesorectal excision(STME).Methods Whole mount sections were prepared by transversely and serially slicing the embedded tissue blocks at 2.5 mm intervals,stained with hematoxylin and eosin,and examined microscopically.The mesorectum was divided into 9 regions.Results Discontinuous cancer spread in outer strip of mesorectum occurred in 14 cases( 45.2% );Metastasis in distal mesorectum which located within 3 cm from distal board of tumor was observed in 2 cases ( 6.5% );Invasion of circumferential resection margin was recorded in 2 cases( 6.5% ).Conclusion The procedure to resect the mesorectum integrally for low rectal cancer is very necessary,in which the distal clearance margin for the mesorectum should reach to 4 cm.