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背景与目的:目前直肠癌远端的安全分子切除长度尚无定论。本研究拟探索直肠癌远端肠壁内浸润的分子长度及其对临床的指导意义,阐明根治性直肠癌远端正常肠管应切除的安全长度。方法:收集1996年8月～1997年10月手术切除的P53阳性直肠癌标本61例,应用大切片P53免疫组化染色、对照常规HE染色,在显微镜下测量远端肠壁内浸润长度,并根据组织回缩比率,换算成活体远端浸润的实际长度;长期追踪随访,用寿命表法估计、比较各组浸润长度的生存曲线。结果:用免疫组化染色观察P53阳性直肠癌,82.0%(50/61)病例向远端浸润,肠壁内扩散的分子长度0.11～3.50cm,平均0.59cm,>3cm仅1例;而用常规HE染色观察,29例(47.5%)发生肠壁内扩散,长度为0.10～1.39cm,平均0.13cm,两组均数比较差异有显著性(P<0.0001);随访结果表明,浸润长度>1cm的病例,其生存率明显低于无远端浸润或浸润<0.5cm组(P<0.05)。结论:用免疫组化染色较常规HE染色测量直肠癌远端浸润长度更准确,对指导临床更有意义。P53阳性直肠癌远端浸润多数在1cm以内,根治术切除肿瘤远端正常肠管3cm对95%以上的病例已安全。浸润长度>1cm的病例生存率明显降低。
BACKGROUND & OBJECTIVE: Currently there is no conclusive result on the length of excision of distal rectal cancer. This study intends to explore the length of the distal intestine infiltration of rectal cancer molecular length and its clinical significance, to clarify the safety of radical resection of colorectal distal normal bowel should be removed. Methods: Totally 61 cases of P53-positive rectal cancer surgically excised from August 1996 to October 1997 were collected. The large section of P53 immunohistochemical staining was used to observe the conventional HE staining. The infiltration length of distal intestinal wall was measured under microscope According to the tissue retraction ratio, converted into the actual length of living infiltration of the long; follow-up long-term follow-up, life table method to estimate the survival curve of the infiltration length of each group. Results: In the group of P53 positive rectal cancer, 82.0% (50/61) cases were infiltrated distally and the molecular diffusion length in the intestinal wall was 0.11-3.50 cm, with an average of 0.59 cm and> 3 cm in only 1 case. Conventional HE staining showed that 29 cases (47.5%) had intestinal wall diffusion with a length of 0.10-1.39 cm (average 0.13 cm). There was significant difference between the two groups (P <0.0001). The follow-up results showed that the infiltration length> 1cm cases, the survival rate was significantly lower than those without distal infiltration or infiltration <0.5cm group (P <0.05). Conclusion: Immunohistochemical staining is more accurate than conventional HE staining in measuring the distal infiltration length of rectal cancer, which is more meaningful to guide the clinical practice. The majority of distal infiltration of P53 positive rectal cancer within 1cm, radical resection of the distal bowel normal bowel 3cm more than 95% of the cases have been safe. Infiltration length> 1cm case significantly reduced the survival rate.