Total anorectal reconstruction with a double dynamic graciloplasty after abdominoperineal reconstruction for low rectal cancer

PURPOSE: Total anorectal reconstruction with a double dynamic graciloplasty was performed after abdominoperineal reconstruction (APR) for low rectal cancer. In four patients an additional pouch was constructed to improve neorectal motility and capacity. The aim of this study was to evaluate the results in the first 20 patients and to report on the preliminary results of patients with an additional pouch. METHODS: Twenty patients with a mean age of 52 (range, 25–71) years and a rectal tumor at a mean of 3 (range, 0–5) cm from the anal verge were treated. In 14 patients the Miles resection, colon pull-through, and construction of a neosphincter were performed in one session. Six patients had the double graciloplasty at an average of 4.1 (range, 1.1–8.8) years after APR. In four patients a pouch was constructed with an isolated segment of distal ileum. RESULTS: After a mean follow-up of 24 (range, 1–60) months after APR, none of the patients developed local recurrence, whereas four patients developed distant metastasis. Fifteen of 20 patients were available for evaluation, and 5 patients were still in training. Of these 15 patients, 8 patients were continent (53 percent), 2 patients were incontinent, and in 5 patients the perineal stoma was converted to an abdominal stoma. Failures were attributable to necrosis of the colon stump (n=2) and incontinence (n=3). At 26 weeks mean resting pressure was 44 (standard deviation (SD), 28) mmHg, and mean pressure during stimulation was 90 (SD, 46) mmHg at a mean of 35 (SD, 1.2) volts at 52 weeks. Mean defecation frequency was three times per day (range, 1–5). Of the eight patients who were continent, six used daily enemas. Mean time to postpone defecation was 11 (range, 0–30) minutes. CONCLUSION: In experienced hands, the double dynamic graciloplasty is an oncologically safe procedure that can have an acceptable functional outcome in a well-selected group of patients. However, to improve the outcome, further modifications will be necessary. So far, the addition of a pouch has not resulted in improved outcome. Supported by the Profileringsfonds of the Maastricht University Hospital, The Netherlands, and by the Stichting Fondsenwervingsactie Volksgezondheid, Amsterdam, The Netherlands. Read in part at the meeting of The American Society of Colon and Rectal Surgeons, Seattle, Washington, June 9 to 14, 1995.     

Intravascular electric impedance spectroscopy of atherosclerotic lesions using a new impedance catheter system

Newer techniques are required to identify atherosclerotic lesions that are prone to rupture. Electric impedance spectroscopy (EIS) can characterize biological tissues by measuring the electrical impedance over a frequency range. We tested a newly designed intravascular impedance catheter (IC) by measuring the impedance of different stages of atherosclerosis induced in an animal rabbit model. Six female New Zealand White rabbits were fed for 17 weeks with a 5% cholesterol–enriched diet to induce early forms of atherosclerotic plaques. All aortas were prepared from the aortic arch to the renal arteries and segments of 5–10 mm were marked by ink spots. A balloon catheter system with an integrated polyimide–based microelectrode structure was introduced into the aorta and the impedance was measured at each spot by using an impedance analyzer. The impedance was measured at frequencies of 1 kHz and 10 kHz and compared with the corresponding histomorphometric data of each aortic segment.Forty–four aortic segments without plaques and 48 segments with evolving atherosclerotic lesions could be exactly matched by the histomorphometric analysis. In normal aortic segments (P0) the change of the magnitude of impedance at 1 kHz and at 10 kHz (|Z|_{1 kHz} – |Z|_{10 kHz}, = ICF) was 208.5 ± 357.6 Ω. In the area of aortic segments with a plaque smaller than that of the aortic wall diameter (PI), the ICF was 137.7 ± 192.8 Ω. (P 0 vs. P I; p = 0.52), whereas in aortic segments with plaque formations larger than the aortic wall (PII) the ICF was significantly lower –22.2 ± 259.9 Ω. (P0 vs. PII; p = 0.002). Intravascular EIS could be successfully performed by using a newly designed microelectrode integrated onto a conventional coronary balloon catheter. In this experimental animal model atherosclerotic aortic lesions showed significantly higher ICF in comparison to the normal aortic tissue.     

Effects of adjuvant radiotherapy on bowel function and anorectal physiology after low anterior resection for rectal cancer

We compared bowel function and anorectal physiology testing in rectal cancer patients who had undergone surgery alone, i.e. low anterior resection with colonic pouch (SA), to those also having preoperative radiotherapy (PREOP) or postoperative radiotherapy (POSTOP). The PREOP group were recruited from those who received 50.4 Gy (28 daily fractions over 5 1/2 weeks), and had their ileostomies closed for at least 1 year. Equivalent gender- and age-matched SA and POSTOP (50.4–54 Gy) patients who were operated upon during the similar time period were recruited. Bowel function questionnaire, anorectal manometry, anal electrosensation, pudendal nerve motor terminal latencies, barostat rectal sensation measurements and endoanal ultrasound were performed. There were 6 patients in each group. Bowel function questioning revealed that PREOP had significantly more incontinent episodes than SA patients (SA 2.9 ± 1.3, PREOP 10.3 ± 3.4, POSTOP 3.8 ± 0.6 episodes per week: p < 0.05; values expressed as mean ± SEM). The rectal volume of initial distension sensation on barostat ramp program testing was more impaired in the POSTOP than in PREOP group (SA 27.4 ± 5.3, PREOP 17.8 ± 4.3, POSTOP 37.5 ± 6.8 ml; p < 0.05). The left pudendal nerve motor terminal latency was more prolonged in the POSTOP than in the SA patients (SA 1.9 ± 0.2, PREOP 2.3 ± 0.1, POSTOP 4.3 ± 0.7 ms; p < 0.05). Patients who had preoperative radiotherapy had more incontinent episodes, and the rectal sensation may be more impaired after postoperative radiotherapy. Received: 30 December 1999 / Accepted: 17 January 2000     

Anal sphincter reconstruction by dynamic graciloplasty after abdominoperineal resection for cancer

PURPOSE: Chronic low-frequency electrical stimulation can safely transform fatiguing muscle into fatigue-resistant muscle. This fundamental discovery was used to reconstruct the anal sphincter. Dynamic graciloplasty was found to be effective in the treatment of fecal incontinence. Our study was undertaken to investigate the oncologic, functional, and quality of life results of dynamic graciloplasty anal reconstruction after an abdominoperineal resection for carcinoma. METHODS: Between April 1993 and April 1996, nine patients (4 males) with a median age of 51.2 (range, 29–69) years underwent an abdominoperineal resection for carcinoma (4 had a rectal adenocarcinoma and 5 had an epidermoidal anal tumor) and an anal sphincter reconstruction with electrically stimulated graciloplasty. Oncologic and functional results were evaluated after a mean follow-up of 32 (range, 14–59) months. A quality of life questionnaire was filled out by seven patients. RESULTS: Sphincter reconstruction required the same hospitalization period as abdominoperineal resection. Two patients died from evolutive disease. Three patients were operated on twice, one for immediate colonic necrosis, two for colonic perforation after enema. One of them refused the graciloplasty and had an abdominoperineal resection. Six patients were dysfunctioned. The mean resting pressure was 24±10 mmHg, and the mean pressure during stimulation was 95±25 mmHg. Five patients were continent for solids and liquid; four wore less than three pads per day, and one wore more than three. Four patients used enemas twice a week; one patient had spontaneous evacuation. The quality of life questionnaire showed that the mean scores for social interaction, symptoms, and psychological and physical states were 2.1, 2.2, 2.4, and 2.7, respectively. The mean value was 1.5 CONCLUSIONS: Total anorectal reconstruction with dynamic graciloplasty is an oncologically safe procedure. Functional results improve with time, but careful patient selection guarantees a successful functional outcome. Technical progress is necessary to improve the quality of life.Supported by a grant from the Ligue Contre le Cancer, Comité de l'Hérault et de l'Aveyron, and the Comité de Lutte contre le Cancer de Ginestas, France.Presented at the International Conference on Gastrointestinal Oncology, Washington, DC, September 12 to 14, 1997.     

埋藏式心脏起搏器置入术后电极阻抗的动态变化及其临床意义

目的　观察埋藏式心脏起搏器置入术后起搏电极阻抗的动态变化规律 ,并探讨其机制及临床意义。方法　对 2 0 0 3年 4月至 2 0 0 3年 10月期间在我院接受埋藏式心脏起搏治疗的 33例患者分别于术中、术后 1w、2w、1个月、2个月、3个月和 6个月测定电极阻抗 ,同时随访起搏器功能状态。结果　 19条MedtronicCAPTURE SP(MCSP)系列心房激素电极阻抗术后均较术中明显降低 ,且差异具有显著性(P <0 0 1) ,术后 1w至 6个月无明显变化 ;2 4条MCSP系列心室激素电极阻抗亦表现出同样的变化趋势。 9条BIOTRONIKSYNOXSX(BSSX)系列高阻抗非激素心室电极阻抗术后亦均较术中明显降低 (P <0 0 1) ,术后 2w最低 ,其与术后 1、2和 3个月比较具有显著性差异 (P <0 0 5 )。所有患者起搏器起搏、感知功能均正常。结论　埋藏式心脏起搏器置入术后电极阻抗于 1w时开始明显降低 ,此后 6个月激素电极阻抗保持稳定 ,而非激素电极在正常范围内出现较大波动 ,但并不影响起搏器正常工作。     

Secondary coloperineal pull-through and double dynamic graciloplasty after miles resection—feasible, but with a high morbidity

PURPOSE: Until recently, patients who underwent abdominoperineal resections had to cope with a colostomy for the rest of their lives. For some of these patients this colostomy was a terrible burden, physically and mentally. Publications about abdominoperineal pull-through and double dynamic graciloplasty immediately after a Miles resection showed good results. The purpose of this study was to investigate the procedure as a secondary approach after abdominoperineal resections. METHODS: In this study seven patients were evaluated. All had had an abdominoperineal resection and proved to have unbearable problems with their stoma. All had a secondary pull-through and double dynamic graciloplasty, a mean of 8.5 (range, 1.1–34.8) years after the Miles resection. RESULTS: In five patients continence was regained; two were reversed to colostomy because of several complications. Patients who had a successful outcome also suffered from numerous complications, with a total mean hospital stay of 73.8 (range, 27–167) days, a mean of 3.1 (range, 1–6) additional operations, and 1.8 (range, 0–4) readmissions. CONCLUSION: Secondary anorectal reconstruction after abdominoperineal resection is a feasible option, but with a high morbidity. Because of this the procedure was stopped at the beginning of 1997.This study was funded by a grant from the National Fund for Investigational Medicine (Ministry of Health), the Netherlands.Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, San Antonio, Texas, May 2 to 7, 1998.     

Recurrence rates after curative surgery for rectal carcinoma,with special reference to their accuracy

Is the observed recurrence rate after curative surgery for rectal cancer always a good measure of therapeutic improvements? In an attempt to answer this question, the rates of local and distant recurrences were studied in two complete series of patients operated on for cure for rectal carcinoma. One hundred one consecutive patients were followed for five years in one series and 231 were followed for at least 18 years in the other series. The recurrence rate in the first series was 39 percent and in the second, with the longer observation time, 54 percent. The local recurrence rates were 24 and 38 percent, respectively. Both local and total recurrence rates increased with the length of the follow-up period. This was especially true for patients with combined local and distant disease. Autopsy sometimes demonstrated recurrences, clinically undiscovered. It is concluded that completeness, long follow-up, and intensive search for recurrence, including a high autopsy rate, are factors that raise both total and local recurrence rates. All these factors are important to consider when comparing results of different treatment modalities.     

Electrical Characteristics of Various Submucosal Injection Fluids for Endoscopic Mucosal Resection

Submucosal fluid injection, prerequisite to endoscopic mucosal resection, necessitates detailed evaluation for proper selection. We aimed to compare height of gastric tissues after submucosal injection, and to verify electrical implications of injectants. Porcine stomach pieces were cut out, and eight solutions were used: normal saline, 0.5% sodium hyaluronate (SH), 0.25% SH, hydroxypropyl methylcellulose, 10% glycerin, fibrinogen, 1% sodium alginate (SA), and 2.5% SA. Elevated heights were measured after submucosal injection of the eight fluids, and electrical impedance was measured for fluids plus a reference solution (0.01 N KCl) with a potentiostat electro-impedance spectrometry and an insulation-tipped knife. Resistivity was calculated thereafter. Normal saline and 10% glycerin solution showed greater height diminution. Resistivity were in the range of 80–110 Ω cm, except for 309.7 Ω cm for fibrinogen. Higher resistivity may improve performance of electrosurgery, probably by strengthening impedance and heat dissipation. Further studies are required to back up this basic experiment for clinical application.     

直肠保肛手术重建后"漏气"的处理技巧和预防策略

与传统的手工缝合相比,器械吻合能够明显缩短手术时间,同时减少术中出血量。术中通常采取"注气注水试验"来检查吻合口有无出血、渗漏以及是否通畅确切。但在重建后仍有一小部分病例存在"漏气"的问题,本文就一例相关病例,结合手术视频,与各位分享个人对此种情况的处理方法和预防策略。     

Prognostic value of additional pathological variables for long-term survival after curative resection of rectal cancer

AIM: To evaluate the prognostic value of some pathological variables in rectal cancer survival. METHODS: 247 patients who underwent curative resection of rectal cancer were included in the study. The influence on survival of five pathological variables (histopathological tumor type, histopathological tumor grade differentiation, blood vessel invasion, perineural invasion and lymphatic invasion) was assessed using statistical analyses. RESULTS: Overall 5-year survival was 71.2%. Univariate analysis of all tested variables showed an effect on survival but only the effect of lymphatic invasion was statistically significant. At stages three and four it had a negative effect on survival (P = 0.0212). Lymphatic invasion also significantly affected cancer related survival in multivariate analysis at stages three and four. At lower stages (stage 0, stage 1 and stage 2) multivariate analysis showed a negative effect of perineural invasion on cancer related survival. CONCLUSION: Patients with lymphatic and perineural invasion have a higher risk for rectal cancer related death after curative resection. Examination of these variables should be an important step in detecting patients with a poorer prognosis.     

Role of p53 and p21/WAF1 detection in patient selection for preoperative radiotherapy in rectal cancer patients

BACKGROUND: Recent studies showed that p53 and p21 may play major roles in determining tumor radiosensitivity through the apoptosis pathway. The aim of this study was to investigate the predicting value of radiosensitivity in human rectal carcinoma. METHODS: p53 and p21/WAF1 expressions in formalin fixed, paraffin-embedded, preradiation biopsy samples from 49 patients with primary rectal carcinoma were analyzed immunohistochemically. p53 and p21 expressions and their relationships with histopathologic changes after radiation and other clinical features were evaluated. RESULTS: Expressions of p53 and p21/WAF1 were 49 and 28.6 percent, respectively. In 36.7 percent of total tumors, significant histopathologic effect can be observed. There was a significant inverse expression of p53 and p21. Most of the p53(+) or p21(–) tumors were radioresistant, and the majority of p53(–) or p21(+) tumors were radiosensitive. Tumors size in the radiosensitive, p53(–), or p21(+) group decreased more significantly than in radioresistant, p53(+), or p21(–) group (P<0.01), and patients with radioresistant, p53(+), or p21(–) tumors had more local recurrence, more distant metastasis, and a shorter five-year survival rate than those with radiosensitive, p53(–), or p21(+) tumors, but without statistic significance. No statistically significant correlation can be observed between other tumor clinical features and radiosensitivity, p53, or p21 expressions. CONCLUSION: Immunohistochemistry detection of p53 and p21 expressions may be useful parameters for more radiosensitive patients selected for preoperative radiotherapy.Supported by a Grant-in-aid for Scientific Research from the Ministry of Education, Science and Culture of Japan.Presented at the meeting of the Asian-Pacific Congress of Gastroenterology, Yokohama, Japan, September 19 to 23, 1996.     

Assessment of regional lung ventilation by electrical impedance tomography in a patient with unilateral bronchial stenosis and a history of tuberculosis

Bronchial stenosis can impair regional lung ventilation by causing abnormal, asymmetric airflow limitation. Electrical impedance tomography (EIT) is an imaging technique that allows the assessment of regional lung ventilation and therefore complements the functional assessment of the lungs. We report the case of a patient with left unilateral bronchial stenosis and a history of tuberculosis, in whom regional lung ventilation was assessed by EIT. The EIT results were compared with those obtained by ventilation/perfusion radionuclide imaging. The patient was using nasal continuous positive airway pressure (CPAP) for the treatment of obstructive sleep apnea syndrome. Therefore, we studied the effects of postural changes and of the use of nasal CPAP. The EIT revealed heterogeneous distribution of regional lung ventilation, the ventilation being higher in the right lung, and this distribution was influenced by postural changes and CPAP use. The EIT assessment of regional lung ventilation produced results similar to those obtained with the radionuclide imaging technique and had the advantage of providing a dynamic evaluation without radiation exposure.     

Acid rereflux: a review,emphasizing detection by impedance,manometry, and scintigraphy,and the impact on acid clearing pathophysiology as well as interpreting the pH record

Acid clearing, the interval while intraesophageal pH is <4 after a traditional acid reflux event (RE), is a potential blind spot during pH monitoring, when reflux of acidified gastric contents may occur undetected by the pH probe. This is termed acid rereflux. Acid rereflux comprised 61% (169/262) of acid REs in recumbent postprandial patients with severe GERD in two reports using simultaneous pH monitoring and manometry as well as multichannel intraluminal impedance (MII) in one, and scintigraphy in the other. Acid rereflux events often recurred with short intervals between them. The pH probe alone was insufficient to detect most acid rereflux REs, since expanding pH criteria for an acid RE (>1 unit fall while pH < 4) detected only 35% of acid rereflux REs. When a variety of patients and study conditions was examined, simultaneous manometry–pH monitoring found more frequent acid rereflux in the following situations: (1) patients with vs those without esophagitis; (2) recumbent vs upright posture, and (3) postprandial vs preprandial. Of pathophysiologic importance, acid rereflux in the blind spot is the most common cause of prolonged daytime acid REs in GERD patients. Of clinical importance, the 24-hr pH parameter % acid exposure should be relied upon most in interpreting the 24-hr pH record, because those parameters that relate to RE frequency may be inaccurate due to acid rereflux REs that are not counted. Furthermore, identifying as many REs as possible gives a more reliable indication of the severity of antireflux barrier incompetence, as well as more REs to correlate with patients symptoms that should improve sensitivity of the symptom index. Ambulatory simultaneous pH monitoring and MII will allow these and other roles for acid rereflux to be assessed during the patients normal day.     

Iatrogenic colorectal perforation induced by anorectal manometry： Report of two cases after restorative proctectomy for distal rectal cancer

There are no reports regarding perforation of the colorectum induced by anorectal manometry. We report two cases of colorectal perforation that occurred during manometry in the patients undergoing restorative proctectomy for distal rectal cancer. In the first patient, computed tomography showed an extraperitoneal perforation in the pelvic cavity and a rupture of the rectal wall. A localized perforation into the retroperitoneum was managed conservatively. In the second patient, a 3 cm linear colon rupture was detected above the anastomotic site. A primary closure of the perforated colon and proximal ileostomy were conducted, but the patient died 2 wk later. We hypothesize that the perforation induced by anorectal manometry may be associated with the relative weakening of the proximal bowel wall due to anastomosis, decreased compliance, and abnormal rectal sensation. We suggest that measurement of the maximum tolerable volume should not be routinely performed alter restorative proctectomy for distal rectal cancer.     

Quantification of histologic regression of rectal cancer after irradiation: a proposal for a modified staging system

PURPOSE: Long-course preoperative radiotherapy has been recommended for rectal carcinoma when there is concern about the ability to perform a curative resection, for example, in larger tethered tumors or those sited anteriorly or near the anal sphincter. Downstaging of the tumor may occur, and this is of importance when estimating the prognosis and selecting postoperative therapy for patients. We studied the effects of preoperative chemoradiotherapy on the pathology of rectal cancer, and we propose a simplified measurement of tumor regression, the Rectal Cancer Regression Grade. METHODS: We have reviewed those patients who received preoperative chemoradiotherapy followed by surgical resection for carcinomas of the mid or distal third of the rectum found to be Stage T3/4 on transrectal ultrasound or CT between January 1995 and December 1998. Patients received 45 to 50 Gy irradiation and an infusion of 5-fluorouracil. The surgical specimens were examined by one pathologist, and the Rectal Cancer Regression Grade was quantified. RESULTS: Forty-two patients, mean age 60 (range, 42–86) years, underwent chemoradiotherapy before surgery for rectal carcinoma. There were 28 anterior resections (67 percent; 9 with a colonic pouch), 12 abdominoperineal resections (27 percent), and 2 Hartmanns procedures (5 percent). Comparison of preoperative and pathologic staging revealed that the depth of invasion was downstaged in 17 patients (38 percent), and the status of involved lymph nodes was downstaged in 13 (50 percent) of 26 patients. Tumor regression was more than 50 percent (Rectal Cancer Regression Grades 1 and 2) in 36 patients (86 percent), with 7 patients (17 percent) having complete regression with absence of residual cancer cells. CONCLUSION: Significant tumor regression was seen in 86 percent of cases after chemoradiotherapy, with 19 patients showing a good responsiveness. We propose a modified pathologic staging system for irradiated rectal cancer, the Rectal Cancer Regression Grade, which includes a measurement of tumor regression. The utility of the proposed Rectal Cancer Regression Grade must be tested against long-term outcomes before its value in predicting prognosis and survival can be determined.     

Mortality,morbidity, and patterns of recurrence after abdominoperineal resection for cancer of the rectum

Records of 230 patients who underwent abdominoperineal resection between 1963 and 1976 were reviewed. The median age of the patients was 62 years. The mortality rate was 1.7 per cent, and the morbidity rate was 61 per cent. One hundred eighty patients were followed for five to 13 years to identify patterns of recurence. Ten-year survival for Dukes' A, B, and C lesions was 83 per cent, 57 per cent, and 31 per cent, respectively. Seventy-eight patients (43 per cent) had recurrent cancer; 10 per cent had local lesions, and 33 per cent had distant lesions. Dukes' B lesions had a greater latency for local recurrence than Dukes' C lesions. Dukes' A lesions with distant recurrence had a greater latency than Dukes' B or C lesions. Once recurrence was established, the survival rate was not significantly different, regardless of Dukes' stage or local or distant site. Radiation therapy for established local recurrence or chemotherapy for established distant recurrence did not seem to alter survival rates. Read at the meeting of the American Society of Colon and Rectal Surgeons, Colorado Springs, Colorado, June 7 to 11, 1981. Aided by a grant from the American Cancer Society, Massachusetts Division, Inc.     

Relationship among electrocardiographic potential amplitude,weight, and resistance/reactance/impedance in a patient with peripheral edema treated for congestive heart failure

We are presenting a 79-year-old woman with congestive heart failure (CHF) and marked peripheral edema, who responded to medical management by losing 19.7% of her weight. The patient was studied with daily weights, 12-lead electrocardiograms (ECGs), and body electrical resistance/reactance/impedance (R/R/I) measurements via electrodes applied on her hand and foot. In the process she showed a gradual increase in the QRS complexes in her daily ECGs pari passu with the weight loss, leading to a 27.4% increase in the sums of the QRS complexes from the 12 ECG leads ( summation operator SQRS). In addition the patient revealed excellent correlations between weights and summation operator SQRS (r = -.91, P =.013), weights and resistance (r = -.95, P =.004), reactance (r = -.86, P =.029), and impedance (r = -.95, P =.004). Other ECG sets including fewer leads were also employed and correlated with weights and the body electrical properties. It is concluded that loss of peripheral edema in patients with CHF is associated with augmentation of body R/R/I leading to augmented ECG QRS complexes. These findings link etiologically changes of ECG potentials to alteration of body electrical properties, and suggest that serial ECGs could be used in the monitoring of therapy of patients with CHF.     

Augmentation of the amplitude of electrocardiographic QRS complexes immediately after hemodialysis: a study of 26 hemodialysis sessions of a single patient,aided by measurements of resistance,reactance, and impedance

An increase in the amplitude of electrocardiogram QRS complexes ( upward arrow QRS) with hemodialysis (HD) has been invariably documented, but the relationship with weight loss has varied, and other parameters (ie, hemoglobin, body electrical properties), which could be determinants of upward arrow QRS, have not all been evaluated in the same patients. We investigated a patient immediately before and after 26 sessions of HD with measurements of a host of variables. Statistically significant correlations were found only between weight loss and net fluid removed (r =.72, P =.0005), and percentage change in the sums of QRS complexes of all 12-electrocardiogram leads and weight lost during HD (r =.41, P =.038). HD imparts a reproducible upward arrow QRS, but variation in all the other intercorrelations can be attributed to the complexity of the procedure and its variable impact on many body parameters.     

直肠癌TME术后检测癌组织及直肠系膜内MMP-7的意义

目的:研究直肠癌患者直肠系膜内MMP-7表达,为全直肠系膜切除术(totalmesorectalexcision,TME)提供理论依据.方法:直肠癌TME术后,应用免疫组化SP法检测47例患者癌组织、直肠系膜(肿瘤平面、肿瘤下缘下2cm和系膜远端)及盆筋膜壁层MMP-7的表达.并与病理组织学染色(常规HE染色)结果进行比较.结果:直肠系膜中MMP-7的阳性表达率为29.8%(14/47),有7例患者只在肿瘤平面系膜内有MMP-7表达,3例在肿瘤平面和肿瘤下缘下2cm处系膜内有MMP-7表达,4例只在肿瘤下缘下2cm有MMP-7阳性表达.常规病理染色阳性率为14.8%(7/47),其MMP-7染色均为阳性.在癌组织中,MMP-7的阳性率为91.5%(14/47).在直肠系膜远端、盆筋膜壁层和对照组织(距肿瘤上缘10cm以上的正常直肠黏膜和系膜)中,MMP-7均无表达.结论:直肠系膜内MMP-7表达可及肿瘤平面和肿瘤下缘下2cm处,但尚未达到直肠系膜远端和盆筋膜壁层.肿瘤的分化程度、肠壁浸润深度和Dukes分期与系膜内MMP-7阳性表达有关.从分子病理学的角度可以认为TME是科学的.