Han Xiao-yan, Wei Hong-bo, Wei Bo, Zheng Zong-heng, Guo Wei-ping
Department of Gastrointestinal Surgery, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2007 May;10(3):226-9.
To investigate the appropriate distal resection margin in rectal cancer patients.
Thirty specimens of rectal carcinoma with total mesorectal excision(TME) were studied by flow cytometry and pathological examination. The differences of DNA ploidy status, DNA index (DI), proliferative index (PI), S-phase fraction (SPF) among rectal cancer, 3 cm and 5 cm below the tumor, normal rectum, distal mesorectum 3 cm and 5 cm below the tumor, and normal colon mesentery were analysed by flow cytometry, and were compared with the data of pathological examination.
Pathological examination showed that there was no tumor invasion 3 cm and 5 cm below the tumor,but the metastasis rates of distal mesorectum 3 cm and 5 cm below the tumor were 26.7% and 6.7% respectively. The DI, PI and SPF of rectal cancer by flow cytometric examination were significantly higher than those of distal rectum 3 cm and 5 cm below the tumor, and normal rectum (P<0.05). The DI, PI and SPF of distal rectum 3 cm below the tumor were also significantly higher than those of distal rectum 5 cm below the tumor, and normal rectum (P<0.05), but there were no significant differences between DI, PI and SPF of distal rectum 5 cm below the tumor and those of normal rectum (P>0.05). The rate of DNA aneuploid of tumor was significantly higher than those of normal rectum and distal rectum 5 cm below the tumor,but there was no significant difference between the rate of DNA aneuploid of tumor and that of distal rectum 3 cm below the tumor. The DI and DNA aneuploid of rectal cancer and distal mesorectum 3 cm and 5 cm below the tumor were significantly higher than those of normal mesorectum,but there were no significant differences between DI and DNA aneuploid of rectal cancer and those of distal mesorectum 3 cm and 5 cm below the tumor. The PI and SPF of rectal cancer were significantly higher than those of normal mesorectum and distal mesorectum 3 cm and 5 cm below the tumor.
Rectal cancer is able to invade distal rectum 3 cm below the tumor and distal mesorectum 5 cm below the tumor, and radical resection of rectal cancer should beyond that range.
探讨直肠癌患者合适的远切缘。
对30例接受全直肠系膜切除术（TME）的直肠癌标本进行流式细胞术和病理检查。通过流式细胞术分析直肠癌、肿瘤下方3 cm和5 cm处的直肠、正常直肠、肿瘤下方3 cm和5 cm处的直肠系膜远端以及正常结肠系膜之间的DNA倍体状态、DNA指数（DI）、增殖指数（PI）、S期分数（SPF）的差异，并与病理检查数据进行比较。
病理检查显示肿瘤下方3 cm和5 cm处无肿瘤浸润，但肿瘤下方3 cm和5 cm处的直肠系膜远端转移率分别为26.7%和6.7%。流式细胞术检查显示直肠癌的DI、PI和SPF显著高于肿瘤下方3 cm和5 cm处的直肠远端以及正常直肠（P<0.05）。肿瘤下方3 cm处直肠远端的DI、PI和SPF也显著高于肿瘤下方5 cm处的直肠远端以及正常直肠（P<0.05），但肿瘤下方5 cm处直肠远端的DI、PI和SPF与正常直肠之间无显著差异（P>0.05）。肿瘤的DNA非整倍体率显著高于正常直肠和肿瘤下方5 cm处的直肠远端，但肿瘤的DNA非整倍体率与肿瘤下方3 cm处直肠远端的DNA非整倍体率无显著差异。直肠癌以及肿瘤下方3 cm和5 cm处直肠系膜远端的DI和DNA非整倍体显著高于正常直肠系膜，但直肠癌的DI和DNA非整倍体与肿瘤下方3 cm和5 cm处直肠系膜远端的DI和DNA非整倍体之间无显著差异。直肠癌的PI和SPF显著高于正常直肠系膜以及肿瘤下方3 cm和5 cm处的直肠系膜远端。
直肠癌能够侵犯肿瘤下方3 cm处的直肠远端和肿瘤下方5 cm处的直肠系膜远端，直肠癌根治性切除应超出该范围。
