直肠癌向远段及淋巴扩散的临床及病理分析

目的研究直肠下段癌向远段肠壁内扩散及淋巴结转移的情况。方法对33例直肠癌患者远段扩散和淋巴结转移与肿瘤大体形态、大小、组织学类型、分化程度、浸润深度、淋巴细胞浸润、嗜酸性粒细胞浸润、纤维化程度、临床分期及手术后短期随访结果等进行多因素相关分析,以寻求导致局部复发的有关因素。结果本组5例(15%)有远段扩散,距离为0.1~2.4 cm。远段肠壁内扩散与细胞分化和嗜酸性粒细胞的浸润程度相关(P<0.05),而其他病理因素则无相关性。14例(42%)有淋巴结转移,其中5例(15%)只有1枚淋巴结转移。淋巴结转移与分化程度、浸润深度、淋巴细胞浸润、嗜酸性粒细胞浸润及远段扩散相关(P<0.01或0.05),而与其他因素无相关性。结论对距离肛门5~6 cm的低位直肠癌,如能争取到肿瘤下方肠管的2 cm安全区和肛周3 cm的清除范围,保留括约肌切除手术(SSR)应属可行。

The clinical and pathological analysis of distal infiltrated and lymph nodes metastasized of rectal cancer

Objective It is to investigate the information of the lower rectal cancer infiltrated distal intestinal intramural and lymph nodes metastasized.Methods The relevant factor inducing local recurrence,distal infiltration,lymph nodes metastasis,tumor gross morphous,size and histological type,differentiating degree,infiltrating degree,lymphocyte infiltrated,eosinophil infiltrated,fibrotic degree,clinical stage and the result of short follow up after surgery were evaluated by multivariate methods in the 33 patients with rectal cancer.Results 5 patients(15%) were distal infiltrated,distance was 0.1 cm to 2.4 cm.The result revealed that distal intestinal intramural infiltration was correlated with cell differentiation and eosinophil infiltration(P<0.05),and was not correlated with other pathological factors.14 patients(42%) were lymph nodes metastasized,5 cases of the total had one lymph node metastasis.lymph nodes metastasis was correlated with differentiating degree,infiltrating degree,lymphocyte infiltrated,eosinophil infiltrated and distal infiltrated(P<0.01 or 0.05).Conclusion If can find 2 cm safe area that away from tumor edge and lymph nodes are resected which 3 cm distal anal,sphincter-saving resection can be executed for lower rectal cancer which distal tumor edge are 5 to 6 cm from anal.