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目的:探讨低位直肠癌远端肠壁内扩散的距离与方向的关系及其影响因素。方法:沿肿瘤对侧纵行剖开21例低位直肠癌标本的肠管,以肿瘤横径右侧为0°,纵径远端为90°,切取45°、90°、135°等3个方向远端肠壁制作成大切片,比较各个方向壁内扩散距离的差异;比较扩散组(11例)和无扩散组(10例)患者性别、年龄、血癌胚抗原CEA水平、淋巴结转移、大体类型、肿瘤直径、肿瘤占肠腔比例、浸润深度、病理分级及分期差异对直肠癌远端壁内扩散的影响。结果:远端45°、90°、135°方向的扩散发生率分别为33.3%(7/21)、47.6%(10/21)、42.9%(9/21),3者比较,差异无统计学意义(x~2=0.946,P=0.730)。远端壁内45°、90°、135°等3个方向扩散的中位距离分别为5.0(3.6~10.0)mm、6.25(5.0~9.0)mm、5.0(3.25~9.25)mm,3者比较,差异无统计学意义(P>0.05)。扩散组和无扩散组患者血CEA水平、肿瘤直径、肿瘤占肠腔比例、浸润深度、病理分期比较,差异有统计学意义(P<0.05)。血CEA水平、肿瘤直径、肿瘤占肠腔比例、浸润深度、病理分期与直肠癌远端壁内扩散存在相关性(P<0.05)。结论:直肠癌向远端肠壁内3个方向扩散的距离无明显差异,传统2 cm远端安全切缘同样适合于45°、135°方向。血CEA、肿瘤直径、肿瘤占肠腔比例、浸润深度、病理分期是直肠癌远端壁内扩散的影响因素。
Objective: To investigate the relationship between diffusion distance and direction in distal rectal wall of low rectal cancer and its influencing factors. Methods: Twenty-one cases of low rectal cancer specimens were dissected along the contralateral longitudinal tumor of the intestine. Tumor diameter was 0 ° on the right side and 90 ° on the distal end. The longitudinal direction of the intestine was cut off at three angles of 45 °, 90 ° and 135 ° The distal gut wall was made into large sections to compare the differences in diffusion distance in all directions. The gender, age, serum CEA level, lymph node metastasis, gross type , The diameter of tumor, the proportion of tumor to intestine, the depth of invasion, the pathological grading and staging differences on the diffusion of distal rectal wall. Results: The incidence of diffusion in distal 45 °, 90 ° and 135 ° directions were 33.3% (7/21), 47.6% (10/21) and 42.9% (9/21), respectively Significance (x ~ 2 = 0.946, P = 0.730). The median distance of diffusion in three directions of distal wall at 45 °, 90 ° and 135 ° were 5.0 (3.6-10.0) mm, 6.25 (5.0-9.0 mm) and 5.0 (3.25-9.25) mm, respectively , The difference was not statistically significant (P> 0.05). The levels of CEA, the diameter of tumor, the ratio of tumor to the intestine, the depth of invasion, and the pathological stage of the patients with and without diffusion group were significantly different (P <0.05). Blood CEA level, tumor diameter, the ratio of tumor to intestine, depth of invasion, pathological stage and distal wall diffusion of rectal cancer were correlated (P <0.05). CONCLUSION: There is no significant difference in the distance of rectal cancer spreading to the distal intestine in 3 directions. The traditional 2 cm distal safety margin is also suitable for 45 ° and 135 ° directions. Blood CEA, tumor diameter, ratio of tumor to intestine, depth of invasion and pathological stage were the influencing factors of distal rectal wall diffusion.