目的 探討直腸癌根治術(shù)中各臨床病理特征、手術(shù)方式等相關(guān)因素對腸腔內(nèi)腫瘤細(xì)胞脫落的影響。
方法 對我科2006年5月至2007年12月期間診斷為直腸癌并行根治手術(shù)的60例患者行前瞻性研究，術(shù)中在離斷腫瘤下端腸管前行腸腔內(nèi)灌洗，收集灌洗液送病理科，用普通涂片、HE染色檢測送檢標(biāo)本中的癌細(xì)胞。統(tǒng)計(jì)檢測結(jié)果，應(yīng)用包括Logistic回歸分析等統(tǒng)計(jì)學(xué)方法分析各因素對術(shù)中腸腔腫瘤細(xì)胞脫落的影響。
結(jié)果 送檢標(biāo)本中，陽性標(biāo)本共有27例，陰性標(biāo)本33例。對可能影響檢出結(jié)果的各因素行單因素統(tǒng)計(jì)分析，結(jié)果患者的年齡、腫瘤大小、TNM分期、手術(shù)時(shí)間及手術(shù)方式這5個(gè)因素的差異有統(tǒng)計(jì)學(xué)意義（P lt;0.05）。進(jìn)一步將這5個(gè)因素行Logistic多因素回歸分析，發(fā)現(xiàn)TNM分期、手術(shù)時(shí)間及手術(shù)方式是影響腸腔內(nèi)腫瘤細(xì)胞脫落的決定因素，其中TNM分期影響最顯著，手術(shù)時(shí)間的影響次之，最后是手術(shù)方式。
結(jié)論 直腸癌根治術(shù)中必須常規(guī)行腸腔內(nèi)灌洗，特別是腫瘤TNM分期晚、瘤體大及手術(shù)時(shí)間長的病例，更需重視腫瘤細(xì)胞脫落導(dǎo)致術(shù)后局部復(fù)發(fā)的風(fēng)險(xiǎn)。雖然腹腔鏡直腸癌手術(shù)中直腸腸腔內(nèi)腫瘤細(xì)胞脫落的幾率較傳統(tǒng)開腹手術(shù)明顯要小，但仍有必要進(jìn)行有效灌洗。
引用本文： 宗華,潘凱,夏利剛,陳小春,鐘克力,李明偉,林烈文,朱暢. 直腸癌根治術(shù)中影響腸腔腫瘤細(xì)胞脫落的多因素分析. 中國普外基礎(chǔ)與臨床雜志, 2009, 16(4): 304-307. doi: 復(fù)制
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| 6. | [1７]Maeda K, Maruta M, Hanai T, et al. Irrigation volume determines the efficacy of “rectal washout” [Ｊ]. Dis Colon Rectum, 2004; 47(10): 1706-1710. |
| 7. | [1８]Sayfan J, Averbuch F, Koltun L, et al. Effect of rectal stump washout on the presence of free malignant cells in the rectum during anterior resection for rectal cancer [Ｊ]. Dis Colon Rectum, 2000; 43(12): 1710-1712. |
| 8. | Heimann TM, Szporn A, Bolnick K, et al. Local recurrence following surgical treatment of rectal cancer. Comparison of anterior and abdominoperineal resection [Ｊ]. Dis Colon Rectum, 1986; 29(12): 862-864. |
| 9. | Michelassi F, Vannucci L, Ayala JJ, et al. Local recurrence after curative resection of colorectal adenocarcinoma [Ｊ]. Surgery, 1990; 108(4): 787-792.[３] 劉力波, 高麗華, 李寬明, 等. 灌注化療栓塞后手術(shù)切除直腸癌31例報(bào)告 [Ｊ]. 中國普外基礎(chǔ)與臨床雜志, 2005; 12(5): 512-513.[４] 楊楓, 張抒, 于瀾, 等. 腹腔鏡超聲刀聯(lián)合應(yīng)用下直腸癌全直腸系膜切除術(shù) [Ｊ]. 中國普外基礎(chǔ)與臨床雜志, 2001; 8(3): 154-155.[５] Umpleby HC, Fermor B, Symes MO, et al. Viability of exfoliated colorectal carcinoma cells [Ｊ]. Br J Surg, 1984; 71(9): 659-663. [６] Gerster AG. Ⅱ. On the Surgical Dissemination of Cancer [Ｊ]. Ann Surg, 1885; 2(8): 98-109.[７] McGrew EA, Laws JF, Cole WH. Free malignant cells in relation to recurrence of carcinoma of the colon [Ｊ]. J Am Med Assoc, 1954; 154(15): 1251-1254.[８] Le Quesne LP, Thompson AD. Implantation recurrence of carcinoma of rectum and colon [Ｊ]. N Engl J Med, 1958; 258(12): 578-582.[９] Killingback M, Wilson E, Hughes ES. Anal metastases from carcinoma of the rectum and colon [Ｊ]. Aust N Z J Surg, 1965; 34: 178-187. |
| 10. | Sobin LH, Wittekind CH Eds. TNM classification of malignant tumors [M]. 6th Ed. New York: Wiley-Liss, 2002: 121-122. |
| 11. | 李甘地， 楊光華. 腫瘤 [A]. 見： 李甘地主編. 病理學(xué) [M]. 第1版. 北京： 人民衛(wèi)生出版社, 2001: 118-120. |
- 1. [1０]Frederick L, David L, Irvin D, et al Eds. AJCC Cancer Staging Handbook [M]. 6th Ed. New York: Springer, 2002: 60.
- 2. [1３]Gofuku J, Shiozaki H, Tsujinaka T, et al. Expression of E-cadherin and alpha-catenin in patients with colorectal carcinoma. Correlation with cancer invasion and metastasis [Ｊ]. Am J Clin Pathol, 1999; 111(1): 29-37.
- 3. [1４]戴冬秋, 陳俊青, 徐惠綿, 等. E-鈣黏附素及α-鏈接素的表達(dá)與胃癌生物學(xué)行為及淋巴結(jié)轉(zhuǎn)移規(guī)律的關(guān)系 [Ｊ]. 中華腫瘤雜志, 2001; 23(1): 35-38.
- 4. [1５]谷化平, 尚培中. 3種黏附分子表達(dá)與老年胃癌臨床病理特征和預(yù)后的關(guān)系 [Ｊ]. 現(xiàn)代腫瘤醫(yī)學(xué), 2007; 15(11): 1638-1640.
- 5. [1６]Naito A, Iwase H, Kuzushima T, et al. Clinical significance of Ecadherin expression in thyroid neoplasms [Ｊ]. J Surg Oncol, 2001; 76(3): 176-180.
- 6. [1７]Maeda K, Maruta M, Hanai T, et al. Irrigation volume determines the efficacy of “rectal washout” [Ｊ]. Dis Colon Rectum, 2004; 47(10): 1706-1710.
- 7. [1８]Sayfan J, Averbuch F, Koltun L, et al. Effect of rectal stump washout on the presence of free malignant cells in the rectum during anterior resection for rectal cancer [Ｊ]. Dis Colon Rectum, 2000; 43(12): 1710-1712.
- 8. Heimann TM, Szporn A, Bolnick K, et al. Local recurrence following surgical treatment of rectal cancer. Comparison of anterior and abdominoperineal resection [Ｊ]. Dis Colon Rectum, 1986; 29(12): 862-864.
- 9. Michelassi F, Vannucci L, Ayala JJ, et al. Local recurrence after curative resection of colorectal adenocarcinoma [Ｊ]. Surgery, 1990; 108(4): 787-792.[３] 劉力波, 高麗華, 李寬明, 等. 灌注化療栓塞后手術(shù)切除直腸癌31例報(bào)告 [Ｊ]. 中國普外基礎(chǔ)與臨床雜志, 2005; 12(5): 512-513.[４] 楊楓, 張抒, 于瀾, 等. 腹腔鏡超聲刀聯(lián)合應(yīng)用下直腸癌全直腸系膜切除術(shù) [Ｊ]. 中國普外基礎(chǔ)與臨床雜志, 2001; 8(3): 154-155.[５] Umpleby HC, Fermor B, Symes MO, et al. Viability of exfoliated colorectal carcinoma cells [Ｊ]. Br J Surg, 1984; 71(9): 659-663. [６] Gerster AG. Ⅱ. On the Surgical Dissemination of Cancer [Ｊ]. Ann Surg, 1885; 2(8): 98-109.[７] McGrew EA, Laws JF, Cole WH. Free malignant cells in relation to recurrence of carcinoma of the colon [Ｊ]. J Am Med Assoc, 1954; 154(15): 1251-1254.[８] Le Quesne LP, Thompson AD. Implantation recurrence of carcinoma of rectum and colon [Ｊ]. N Engl J Med, 1958; 258(12): 578-582.[９] Killingback M, Wilson E, Hughes ES. Anal metastases from carcinoma of the rectum and colon [Ｊ]. Aust N Z J Surg, 1965; 34: 178-187.
- 10. Sobin LH, Wittekind CH Eds. TNM classification of malignant tumors [M]. 6th Ed. New York: Wiley-Liss, 2002: 121-122.
- 11. 李甘地， 楊光華. 腫瘤 [A]. 見： 李甘地主編. 病理學(xué) [M]. 第1版. 北京： 人民衛(wèi)生出版社, 2001: 118-120.