【摘要】 目的:对直肠癌低位前切除术肿瘤下切缘不同阶段长度的测量,探讨其变化规律。同时分析切缘对局部复发率和生存率的影响。方法:选择距肛缘≤8cm的直肠癌行低位直肠前切除术患者 184例,全部病例均行全直肠系膜切除术(TME)。对每例直肠标本的三个不同阶段的肿瘤下切缘进行测量:①术中切缘;②离体切缘;③化学固定后切缘(简称固定切缘)。计算不同阶段切缘的收缩率。对不同长度切缘对生存率和局部复发率的影响进行比较。结果:全部病例经病理检查切缘均无肿瘤残留。术中切缘、离体切缘、固定切缘均呈缩短趋势,其平均长度分别为: 4. 6cm(SD=0. 9)、3. 3cm(SD=1. 1)、2. 0cm(SD=0. 9)。切缘长度平均收缩率分别为:①离体切缘与术中切缘收缩率 71. 7%;②固定切缘与离体切缘收缩率 60. 1%;③固定切缘与术中切缘收缩率 43. 5%。全组局部复发 12例(6. 5% )。生存分析结果表明:离体切缘≤2cm者与>2cm者相比,以及固定切缘≤1cm与 >1cm者相比,其总生存率和局部复发率均无统计学差异(P>0. 05)。结论:直肠癌低位前切除术肿瘤下切缘的估计应考虑切缘的收缩率。直肠切除后应立即对离体标本的下切缘进行测量,其数据较为准确。我们的资料表明:离体切缘≤2cm者与>2cm者对总生存率和局部复发率的影响无显著差异。更多还原

【Abstract】 Purpose:The authors’ aim was to measure the len gth of distal margin between the lower border of the tumor at different times in low anterior resection for rectal cancer and analyze their relations to prognos is. Methods:In 184 patients, who underwent low anterior resection, the distal margin of sample was measured at the time before resection (BRM), jus t after removing of the specimen (ARM), and after fixation (FM) of the same spec imen. Different distal margins in relation to survival and local recurrence were analyzed. Results:The distal margin of specimen shrank at different times of measurement. The shrinkage ratio was 71.7%, 60.1%, and 43.5% from BRM (mean= 4.6, SD=0.9) to ARM (mean=3.3, SD=1.1), ARM to FM (mean=2.0, SD=0.9), and BRM to FM respectively. The ARM was ≤ 2 cm and > 2 cm in 36 (20%) and 148 (80%) patie nts respectively, and the FM was ≤ 1 cm and > 1 cm in 42 (23%) and 142 (77%) pa tients respectively. Of the 12 patients (6.5%) who developed local recurrence, 4 patients had ARM of ≤ 2 cm and 8 patients had ARM of > 2 cm. Survival analysis demonstrated that the overall survival and local recurrence was not significant ly different between patients with ARM of ≤ 2 cm and patients with that of > 2 cm, and also between patients with FM of ≤ 1 cm and patients with that of > 1 c m. Conclusions:The shrinkage of distal margin at different times s hould be considered in low anterior resection for rectal cancer. Our data sugges t that for patients with rectal cancer undergoing low anterior resection, distal margins ≤ 2 cm immediately measured just after resection of specimen do not se em to affect the outcome.更多还原