胃癌浸润距离的研究与临床应用

目的 探索在术中准确确定足够的胃壁切除范围,保证手术质量,提高患者生存率。方法 以肿瘤边缘为中心向两侧逐渐取材(胃窦部肿瘤取上边缘,胃底贲门部肿瘤取下边缘,胃体部肿瘤取离体标本中较远一侧)、石蜡包埋、染色,判断肿瘤侵犯距离。结果 黏膜层浸润距离≥5 cm的5例,3 cm≤黏膜层浸润距离＜5 cm的5例,0≤黏膜层浸润距离＜3 cm的118例,总计黏膜层浸润距离≥0 cm的128例,黏膜层浸润距离＜0 cm(即镜下所见浸润距离小于肉眼所见浸润距离)的218例。浆膜层浸润距离≥5 cm的6例,3 cm≤浆膜层浸润距离＜5 cm的19例,0≤浆膜层浸润距离＜3 cm的226例,总计浆膜层浸润距离≥0 cm的251例,浆膜层浸润距离＜0 cm的95例。经单因素分析结果表明:黏膜在镜下浸润距离是否大于肉眼所见距离与性别、年龄、最大直径、厚度、间质量和TNM分期相关。黏膜浸润距离与性别、垂直直径、肿瘤厚度、间质量和TNM分期相关。浆膜浸润距离与垂直直径、最大直径、肿瘤厚度、大体类型、组织学类型、间质量、浸润方式和TNM分期相关。结论 99%的患者肿瘤侵犯距离在5 cm以内,所以手术保证5 cm的手术切缘是必要的。肿瘤浸润距离与肿瘤的垂直直径、肿瘤厚度、间质量、浸润方式和TNM分期密切相关。

The research and clinical application of gastr ic carcinoma with infiltration distance

Objective To explore the intraoperative process and determine that the stomach resection margin is accurate so as to ensure the quality of operation and improve the patients′survival rate .Method Nor-mally,tissue samples were continuously collected from two sides of visualized tumor edge as center .Specifically, the tissue samples were collected from upper side when tumor located at gastric antrum ,collected from lower side when tumor located at gastric cardia ,and collected from distant side when tumor located at gastric body .All sam-ples were processed with paraffin embedding ,staining,and were judged by the distance of tumor cell infiltration . Results The mucosa infiltration distance was more than 5 cm in 5 cases,more than 3 cm but less than 5 cm in 5 cases,and less than 3 cm in 118 cases.A total of 218 cases had less 0 cm mucosa infiltration distance ,which was visualized distance less than the microscopic .The serosa infiltration distance was more than 5 cm in 6cases,more than 3 cm but less than 5cm in 19 cases,and more or equal than 0 cm in 251 cases.A total of 95 cases had less 0 cm infiltration distance .The results of the single factor analysis showed that whether the general observed infil -tration distance of the mucosal membrane was greater than what observed under the microscope ,is associated with gender,age, maximum diameter,thickness of the tumor,external quality,and TNM stage.It significantly demon-strated the relationship of microscopic mucous membrane infiltration distance with sex , vertical diameter , thick-ness,stroma mass,and TNM stage.Stroma membrane infiltration distance significantly correlated with vertical di-ameter,the largest diameter,thickness,gross type,histological type,stroma mass,and TNM stage.Conclusion The infiltration of distance was less than 5 cm among ninety nine percent of patients with gastric cancer .There-fore,enlarged resection of 5 cm from visualized margin of tumor is necessary for operative treatment .There are as-sociations between tumor infiltration distance and vertical diameter ,thickness,stroma mass,manner of infiltration, and TNM stage .