中低位直肠癌系膜浸润程度的临床研究

目的探讨中低位直肠癌直肠系膜浸润程度与临床病理特征及预后的关系。方法采用大组织切片技术，测量行全直肠系膜切除术的49例中低位直肠癌标本的肿瘤浸润深度及直肠系膜厚度，计算直肠系膜浸润程度；并分析其临床病理特征和随访结果。结果本组中低位直肠癌术后局部复发率为12．2％（6／49），远处转移率为26．5％（13／49）。直肠癌直肠系膜浸润程度Ⅰ度20例（40．8％），Ⅱ度13例（26．5％），Ⅲ度16例（32．7％），Ⅰ、Ⅱ、Ⅲ度者术后局部复发率分别为0、7．7％和31．3％（X^2=7．357，P=0．015）；远处转移率分别为10％、23．1％和50％（X^2=7．405，P=0．025）；5年生存率则分别为90．9％、69．2％和28．6％（p=0．013）。直肠系膜浸润程度与肿瘤直径（X^2=6．849，P=0．033）、T分期（X^2=34．845，P=0．000）、N分期（X^2=17．266，P=0．002）有关。结论直肠系膜浸润程度是影响直肠癌预后的重要因素。

A clinical study on the degree of mesorectal tumor invasion in middle-low rectal cancer

Objective To study the relationship between the degree of mesorectal tumor invasion and prognosis of the patients with middle-low rectal cancer. Methods Specimens from 49 patients with middle-low rectal cancer, undergone total mesorectal excision in our hospital from April 2003 to December 2003,were studied by large slice pathologic technique. The thickness of mesorectum and the depth of tumor infiltration were measured, and the degree of mesorectal tumor invasion was calculated. The local recurrence rate, metastasis rate and 5-year survival rate were investigated respectively. Possible clinieopathological influence factors were also analyzed. Results The local recurrence rate was 12.2% （6/49）, the distant metastasis rate was 26.5% （13/49）. In three different degrees of mesorectal tumor invasion （ Ⅰ , Ⅱ, Ⅲ）, the local recurrence rates were 0, 7.7% and 31.3% （X^2=7.357, P=0.015）; the metastasis rates were 10%, 23.1% and 50%（X^2=7.405, P=0.025）; the 5-year survival rates were 90.9% , 69.2% and 28.6% （log-rank, P=0.013）. Tumor diameter, T and N staging were risk factors influencing the degree of mesoreetal tumor invasion（X^2= 6.849 P=0.033, X^2=34.845 P=0.000, X^2=17.266 P=0.002）. Conclusions The degree of mesorectal tumor invasion is an important predictor of local and distant metastasis as well as survival of patients in middle-low rectal carcinoma. The degree of mesorectal tumor invasion in the middle-low rectal carcinoma is significantly correlated with tumor diameter, T and N stage.