RT-PCR检测直肠癌在直肠系膜的播散范围及临床意义

目的　以CEAmRNA为标记物 ,应用RT PCR技术检测直肠癌在直肠系膜的播散范围 ,以探讨直肠癌根治术直肠系膜的合理切除范围。方法　 4 0例直肠癌全系膜切除的手术标本 ,取不同距离的直肠系膜以CEAmRNA为标记物 ,应用RT PCR技术检测其有无癌转移。结果　在 4 0例病例中发现直肠系膜有癌播散者 9例 (2 2 .5 % ) ,播散最远距离在肿瘤下缘下 4cm。直肠癌在直肠系膜的播散与Dukes分期、肿瘤浸润肠壁深度、肿瘤分化程度及肿瘤分型相关 (P<0 .0 5 ) ,与肿瘤大小及CEA水平无明显相关性 (P>0 .0 5 )。结论　直肠癌根治术中距肿瘤下缘 5cm范围是直肠系膜的安全切缘。

Detection of Spreading Scope of Rectal Cancer to Mesorectum with RT-PCR and Its Clinical Significance

Objective To detect the spreading scope of rectal cancer to mesorectum by RT PCR using carcinoembryonic antigen (CEA) mRNA as a marker and to investigate the excision scope of mesorectum in resection of rectal cancer. Methods Forty specimens from 40 rectal cancer patients who underwent curative operation was employed to detect the metastatic deposits scattered in the mesorectum by RT PCR using CEA as a marker. Results Nine of 40 (22.5%) specimens contained metastatic deposits scattered in the mesorectum. The metastasis was just within the range of 4cm mesorectum under the verge of tumor. The tumor spreading to mesorectum is correlated with Dukes stages,the infiltrated depth of bowel wall, tumor differentiation and tumor type( P <0.05), and is not correlated with the size of tumor and the level of CEA( P >0.05). Conclusion The excision of mesorectum should be within the range of 5cm under the verge of tumor in surgical management of rectal cancer.