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目的 探索直肠癌全直肠系膜切除术 (TME)的必要性和选择性全直肠系膜切除术(STME)的最佳切除范围。方法 以 31例直肠癌TME手术标本为对象 ,纵向由远及近以 5mm的间距连续取材 ,常规固定包埋 ,大组织切片机以 2 .5cm的间隔连续切片 ,HE染色 ,光学显微镜观察结果。将直肠系膜等分为内、中、外三个带 ,每带按左、右、后三个方向分为三个区 ,直肠癌在直肠系膜内的转移灶分别定位于上述九个区。结果 直肠系膜外带内癌转移 1 4例 (4 5 .2 % ) ,全部为低位直肠癌 ;远端直肠系膜 (DMR)内癌转移 2例 (6 .5 % ) ,均在原发灶下缘以远 3.0cm以内 ;环周切缘癌浸润 2例 (6 .5 % )。结论 低位直肠癌根治手术时 ,完整地切除直肠系膜非常必要 ;远端直肠系膜的切除应达到肿瘤下缘以远 4cm。
Objective To explore the necessity of total mesorectal excision (TME) for rectal cancer and the optimal resection range of selective total mesorectal excision (STME). Methods Thirty-one cases of TME specimens of rectal cancer were treated longitudinally with a distance of 5 mm. The specimens were fixed and embedded regularly. Large sections were cut at intervals of 2.5 cm, and stained with HE and observed with light microscope. The mesorectal mesentery is divided into three parts: internal, external and external. Each belt is divided into three zones according to the left, right and rear directions. The metastases of the rectal cancer in the mesorectum are respectively located in the above nine zones. Results Tumor metastasis in the mesorectum was found in 14 cases (45.2%), all of which were in the low rectal cancer. Two cases (6.5%) of the metastasis in the distal mesorectal membrane (DMR) were in the primary tumor Margin within 3.0cm; 2 cases of peripheral incision edge cancer (6.5%). Conclusions In the treatment of low rectal cancer, it is very necessary to completely remove the mesorectum. The removal of the distal mesorectal membrane should reach 4cm beyond the lower edge of the tumor.