摘要
目的探索早期结直肠癌淋巴结转移的规律和相关因素,探讨其治疗方法以及“高级别上皮内瘤变”这一新概念在临床应用中的一些注意事项。方法对复旦大学附属肿瘤医院1985年1月至2000年12月手术治疗的61例黏膜肌层浸润和黏膜下层浸润的早期结直肠癌病例的临床资料进行回顾性分析,并对其中48例行根治性手术的病例选用细胞角蛋白(CK)的单抗、经免疫组化法进行淋巴结微转移的检测。结果黏膜肌层癌变时25%(4/16)的病例可出现区域淋巴结微转移,黏膜下层癌变时则有31.3%(10/32)的病例可出现淋巴结微转移和转移。在黏膜肌层和黏膜下层浸润的早期结直肠癌中,淋巴结微转移的发生和肿瘤大小相关,当肿瘤最大径≥3cm时微转移多见(P=0.031)。黏膜下层浸润时,淋巴结微转移的发生还和癌变的腺瘤类型(绒毛状腺瘤)、浸润深度(sm3)密切相关(P值分别为0.039和0.018)。随访发现11.5%(3/26)的黏膜肌层癌变病例,有局部复发、血道转移等恶性生物学行为表现。结论黏膜肌层浸润的早期结直肠癌病例中已可以出现区域淋巴结的微转移,当癌变浸润至黏膜下层时淋巴结微转移和转移的发生率更高。在早期结直肠癌的治疗中,选择局部切除手术需要慎重。当肿瘤最大径≥3cm、癌变腺瘤为绒毛状腺瘤或有证据提示黏膜下层浸润已达sm3时。
Objective Try to find out the rule of metastasis of regional lymph nodes in patients with early colorectal carcinoma and discuss the suitable treatment for these patients and several questions when using the new concept of high grade intraepithelial neoplasia. Method A retrospective review was performed of 61 patients with invasive colorectal carcinoma in the layers of muscularis mucosae (mmCRC) and submucosa (smCRC).The lymph nodes of 48 patients who were treated with radical resection were detected to find the micrometastasis using the monoclonal antibodies against cytokeratins (CK) and immunohistochemical techniques. Results Among the patients with mmCRC,25% (4/16) had regional lymph nodes micrometastasis while among the patients with smCRC 31.3% (10/32) had regional lymph nodes micrometastasis and metastasis.The presence of lymph nodes micrometastasis in these patients was related to the tumor size.When the maximum diameter of the carcinoma was more than 3cm,lymph node micrometastasis could be easily detected (P=0.031).Micrometastasis was also related to the type of carcinoma (villous adenoma, P=0.039) and depth of submucosal invasion (sm3,P=0.018) in patients with smCRC.The follow-up showed that among the patients with mmCRC,11.5% (3/26) had malignant biological behavior,such as got local recurrence or clinical metastasis.Conclusion There could already have some micrometastasis of regional lymph nodes in patients with mmCRC, and the incidence of micrometastasis and metastasis would be higher in patients with smCRC.It must be careful when we choose local excision in treating these patients. When the patient got villous adenoma that contains invasive carcinoma,and the maximum diameter of the carcinoma was more than 3cm,or there was evidence of sm3 invasion,it is better to perform radical resection.It must be caution when the new concept of high-grade intraepithelial neoplasia is widely used in diagnosing the early mmCRC.
出处
《中国实用外科杂志》
CSCD
北大核心
2005年第5期273-277,i005,共6页
Chinese Journal of Practical Surgery
关键词
早期
结直肠癌
黏膜肌层浸润
淋巴结微转移
淋巴结转移
上皮肉瘤
肿瘤
Early colorectal carcinoma Invasion in the layer of muscularis mucosae Lymph node micrometastasis Lymph node metastasis Intraepithelial neoplasia
