[摘要] 目的 利用大组织切片技术对直肠癌淋巴结转移的情况进行观察,并分析与临床病理特征的关系。方法 将2005年6月～2008年12月的148例行全直肠系膜切除术的直肠癌患者随机分为两组,试验组76例采用大组织切片技术,对照组72例采用传统病理技术,对比研究淋巴结转移情况,并对影响淋巴结转移的临床病理因素进行分析。结果 试验组平均检出淋巴结(16.8±3.9)枚,阳性淋巴结(2.3±3.6)枚,对照组平均检出淋巴结(10.7±2.1)枚,阳性淋巴结(1.1±2.1)枚,差异均存在在统计学意义(t=11.932,P=0.000;t=2.339,P=0.021)。有淋巴结转移的病例淋巴结检出个数与无淋巴结转移的病例淋巴结检出个数试验组差异无统计学意义(t=1.049,P=0.298),对照组差异存在统计学意义(t=5.762,P=0.000)。不同大体分型、肿瘤直径、累及肠壁周径程度、T分期、分化程度的肿瘤淋巴结转移率不同(χ2=12.979,P=0.002;χ2=5.543,P=0.020;χ2=8.096,P=0.044;χ2=11.478,P=0.006;χ2=9.377,P=0.009)。结论 大组织切片技术能较好的研究直肠癌淋巴结转移情况,直肠癌淋巴结转移与大体分型、肿瘤直径、累及肠壁周径程度、T分期及分化程度存在相关。
[关键词] 直肠肿瘤; 淋巴转移; 病理学
[中图分类号] R735.37 [文献标识码] A [文章编号] 1673-9701(2009)33-03-03
Large Slice Technique for Lymph Node Metastasis ofRectal Cancer
YU Hongwei1 JIANG Nan2 LIU Jinhong3
1.Department of General Surgery,the Affiliated Hospital of Mudanjiang Medical College,Mudanjiang 157001,China;2.Department of General Surgery,the First Affiliated Hospital of Tsinghua University,Beijing 100016,China;3.Department of Pathology,the First Affiliated Hospital of Tsinghua University,Beijing 100016,China
[Abstract] ObjectiveTo investigate the mesorectal lymph node metastasis of rectal cancer by the large slice technique and to identify the correlation of the metastasis with clinicopathological characteristics. MethodsFrom June 2005 to Nov 2008,148 patients with rectal cancer who underwent total mesorectal excision were randomly divided into two groups,trail group(n=76) and control group(n=72). The trail group was examined by the large slice technique,the control group was examined by the traditional pathological methods,and lymph nodes metastasis was compared between two groups. Possible influencing clinicopathological factors were also analyzed. ResultsThe number of the lymph nodes detected from the trail group was 16.8±3.9 and that of the positive lymph nodes was(2.3±3.6),while the number of the lymph nodes of the control group was(10.7±2.1) and that of the positive nodes was(1.1±2.1),with a significant difference between two groups(t=11.932,P=0.000;t=2.339,P=0.021). There was no significant difference in the harvested lymph nodes between the patients with and without lymph node metastasis in trail group(t=1.049,P=0.298),with a significant difference in the control group(t=5.762,P=0.000). Massive type,tumor diameter,involvement extent of perimeter,T staging and differentiating degree were proved to be independent factors influencing the lymph node metastasis in rectal cancer(χ2=12.979,P= 0.002;χ2=5.543,P=0.020;χ2=8.096,P=0.044;χ2=11.478,P=0.006;χ2=9.377,P=0.009). ConclusionThe large slice technique can be well used to study the lymph node metastasis of rectal carcinoma. Lymph node metastasis of rectal cancer has a significant correlation with massive type,tumor diameter,involvement extent of perimeter,T staging and differentiation.
[Key words]Rectal neoplasm; Lymphatic metastasis; Pathology
获取直肠癌淋巴结包含传统方法以及溶脂法等[1],但均不能观察直肠系膜浸润程度、直肠系膜内转移灶及环周切缘状态,大组织切片技术[2]不仅能够明确这些情况,而且能够获得淋巴结的转移情况,本文探讨利用该技术获取直肠癌淋巴结的情况。
1 资料与方法
1.1 一般资料
我院普外科2005年6月～2008年12月同一医师完成的直肠癌根治性切除手术患者148例,其中男性84例,女性64例,年龄17～82岁,中位数59岁,肿瘤距齿状线0～10cm,所有患者均照全直肠系膜切除术标准进行手术切除。随机分为两组,试验组76例,利用大组织切片病理技术检查淋巴结转移情况,对照组72例,通过传统病理技术检查淋巴结转移情况,两组患者在性别、年龄构成、肿瘤T分期、手术方式上均无区别。见表1。
1.2 研究方法
观察标本直肠系膜是否完整,不完整者排除。试验组通过大组织切片病理技术观察淋巴结转移情况;自肠系膜下动脉注入100g/L甲醛150～200mL,肠腔内塞入适量棉球以保持自然扩张,置入100g/L甲醛2000mL 48～72h;自远端起每间隔1cm厚度进行横切面取材,切片逐步脱水脱脂,火棉胶固定,AO滑动式切片机15～20μm厚度切片,苏木精――伊红染色;由病理科医生行组织细胞学观察,除一般病理学检查外,重点观察淋巴结转移情况。对照组按传统病理方法检查淋巴结转移情况。
1.3 统计学方法
统计学处理采用SPSS 12. 0软件完成,样本均数比较行t 检验或方差分析,淋巴结转移与临床病理因素间关系行单因素分析。
2 结果
2.1 直肠癌淋巴结转移情况
试验组46.1%(35/76)的患者存在阳性淋巴结,共检出淋巴结1277枚,平均每例16.8枚;171枚淋巴结转移,阳性率13.4%。对照组34.7%(25/72)的患者存在阳性淋巴结,共检出淋巴结770枚,平均每例10.7枚;81枚淋巴结转移,阳性率10.5%。两组病例在检出淋巴结数、阳性淋巴结数、直肠系膜淋巴结数、直肠系膜阳性淋巴结数、肿瘤旁淋巴结数、肿瘤旁阳性淋巴结数上差异有统计学意义,中央群淋巴结数、中央群阳性淋巴结数差异无统计学意义。见表2。
试验组有淋巴结转移的病例淋巴结检出个数与无淋巴结转移的病例淋巴结检出个数差异无统计学意义,各组淋巴结数差异均无统计学意义。对照组有淋巴结转移的病例淋巴结检出个数与无淋巴结转移的病例淋巴结检出个数差异有统计学意义,直肠系膜、肿瘤旁淋巴结数分别存在统计学差异,而中央群淋巴结检出个数在有无淋巴结转移的病例间无统计学差异。见表3。
试验组中央群、直肠系膜、肿瘤旁淋巴结数差异有统计学意义,两两比较均存在统计学差异;各组阳性淋巴结数有统计学差异,两两比较发现中央群阳性淋巴结数与另外两组存在统计学差异。见表2。3例患者各组均有淋巴结转移,1例患者直肠系膜和肿瘤旁淋巴结无转移但中央群淋巴结存在转移。
2.2 直肠癌淋巴结转移与临床病理特征的关系
大组织切片技术研究发现,不同的大体分型、肿瘤直径(≥5 cm与