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目的 研究直肠癌在直肠系膜内及环周切缘的播散转移规律 ,为合理施行直肠癌手术提供病理学证据。方法 对 6 2例直肠癌患者行全直肠系膜切除术 (TME) ,手术标本制作直肠及全层系膜大组织切片 ,HE染色 ,显微镜观察。结果 期病例中 ,直肠系膜外带 (左、后、右三区 )癌灶占 4 3.2 4 %。直肠侧壁肿瘤 ,系膜同侧癌灶多于对侧 (P<0 .0 5 )。远端直肠系膜内癌播散距原发灶 1～ 3.5 cm,均为 TNM 、 期患者 ,发生率为 12 .9% (8/6 2 )。肿瘤环周切缘癌浸润 (CMI)与肿瘤分化及 TNM分期相关 ,直肠不同部位 CMI发生率无明显差别 (P>0 .0 5 )。结论利用大组织切片技术 ,能够全面观察直肠、直肠系膜及其癌灶分布。系膜外带及肿瘤同侧系膜内癌灶分布较多。手术应完整切除肿瘤远端 4 cm直肠及其周围系膜。 TME减少了癌残留及环周切缘癌浸润可能 ,应作为直肠癌手术的基本原则
Objective To study the rule of disseminated metastasis of rectal cancer in the mesorectum and peritumoral margins and to provide pathological evidence for the rational operation of rectal cancer. Methods Totally 62 patients with rectal cancer underwent total mesorectal excision (TME). The rectum and whole mesangial tissue sections were made by surgical specimens. The specimens were stained with HE and observed with a microscope. Results cases, the mesorectum (left, right, third area) cancer accounted for 4 3.2 4%. The tumors in the rectum and the ipsilateral side of the mesangium were more than those in the contralateral side (P <0.05). The distant mesorectal cancer disseminated from the primary tumor 1 ~ 3.5 cm, all TNM, the incidence of patients, the incidence was 12.9% (8/62). There was no significant difference in the incidence of CMI between different sites of rectal cancer (CMI) in tumor resection margin and TNM stage (P> 0.05). Conclusion The use of large tissue section technique can fully observe the distribution of rectum, mesorectum and its foci. Mesangium band and tumor ipsilateral Department of membranous foci distribution more. Surgery should be complete removal of the distal tumor 4 cm rectum and its surrounding mesangium. TME reduces the possibility of cancer residue and peri-cancerous margins, and should be used as a basic principle of rectal cancer surgery