摘要
目的探讨中低位直肠癌全直肠系膜切除术(TME)后系膜内淋巴结微转移及其与临床病理因素的相关性。方法 31例中低位直肠癌患者接受了 TME 手术,应用脂肪清除技术获取全部淋巴结。将 HE 染色无转移的淋巴结标本进一步行抗 CK 抗体免疫组化染色,检测淋巴结内肿瘤微转移情况,并分析其与临床病理因素之间的相关性。结果 31例标本检出1007枚淋巴结。常规病理发现105枚淋巴结转移,直径为(5.5±3.1)mm;未见癌转移的淋巴结其直径为(2.8±1.5)mm,两组直径差异显著(P<0.05)。在 HE 染色无转移的902枚淋巴结中,26枚发现微转移,其直径为(3.3±1.2)mm,显著小于常规病理有转移的淋巴结[(5.5±3.1)mm,P<0.05],与常规病理无转移淋巴结直径差异不明显。有微转移的淋巴结其直径大部分<5 mm(88.5%)。31例患者中14例(38.7%)发现微转移;HE 染色淋巴结无转移病例中微转移率为14.3%(2/14)。直肠系膜内淋巴结微转移与病理分期、血清癌胚抗原水平及肿瘤分化程度相关(P<0.05)。结论脂肪清除技术综合微转移的检测方法可使 TME 标本得到更多淋巴结,并能更加准确地判断淋巴结转移情况,有助于对直肠癌患者进行更加准确的临床分期并指导个体化治疗。
Objective To assess the correlation between micrometastasis in mesorectum and pathological factors after total mesorectal excision（TME） in lower rectal cancer. Methods All lymh nodes were obtained by fat clearance from 31 lower rectal cancer patients with TME. The lymph nodes which had previously been considered negative of metastasis by conventional examination were submitted to immunohistochemical examination to identify the micrometastases using anti-cytokeratin antibody. The correlation between micrometastasis and pathological factors were analyzed. Resutls One thousand and seven LNs were collected from 31 patients. One hundred and five LNs were found positive by conventional examination, and the mean diameter was （5.5 ± 3.1 ） mm. The mean diameter of conventional negative LNs was （2. 8 ± 1.5 ） mm. The diameter differed significantly between conventional positive and negative LNs （P 〈 0. 05 ）. In 902 conventional negative LNs, 26 contained micrometastasis （2. 9% ） and the mean diameter was （3.3 ± 1.2） mm. The diameter of LNs with micrometastasis was significantly smaller than that of conventional positive LNs （P 〈0. 05）. The diameter of most of the micrometastatic LNs （88.5% ） was less than 5 mm. Forteen patients （38.7%） contained micrometastasis. The pathological stage, serum carcinoembryonic antigen level and tumor differentiation were related to micrometastasis （P 〈 0. 05 ） . Conclusions With the detection of micrometastasis after fat clearance, we can estimate the LN metastasis status more accurately. It can be useful in clinical staging and individual treatment of rectal cancer.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2007年第21期1472-1474,共3页
Chinese Journal of Surgery
关键词
直肠肿瘤
淋巴结
肿瘤转移
Rectal neoplasms
Lymph nodes
Neoplasm metastasis
作者简介
通讯作者：范铁，Email：fantie7876@126．com
