CAJ | 학술논문

目的探讨新辅助治疗对超低位直肠癌淋巴结转移及其微转移规律及分布的影响,为手术方式的选择提供依据.方法运用大组织切片苏木精-伊红染色和组织芯片CK20染色方法,研究超低位直肠癌新辅助治疗组(21例)与直接手术组(23例)行Miles手术后的大体标本.结果新辅助治疗组21例患者直肠系膜共检获淋巴结138枚,其中转移淋巴结39枚,微转移12枚;7例为淋巴结癌转移,2例为淋巴结微转移,6例为病理完全缓解.直接手术组23例患者的直肠系膜共检获淋巴结415枚,其中转移淋巴结169枚,微转移59枚;12例为淋巴结癌转移,4例为淋巴结微转移.两组直肠系膜外带与前区的转移淋巴结分别占21.5％(11/51)与29.0％(49/169)、17.6％(9/51)与17.2％(29/169).坐骨直肠窝转移淋巴结分别占该区总淋巴结的25.0％(3/12)与22.2％(8/36),该区淋巴结转移或微转移者分别占总病例数的4.8％(1/21)与13.0％(3/23).结论新辅助治疗影响超低位直肠癌区域淋巴结的转移与分布,新辅助治疗组肛门括约肌累及较直接手术组显著降低,坐骨直肠窝内极少发生淋巴结转移,Miles手术作为超低位直肠癌新辅助治疗后标准术式的价值应重新评估.
목적 탐토신보조치료대초저위직장암림파결전이급기미전이규률급분포적영향,위수술방식적선택제공의거.방법 운용대조직절편소목정-이홍염색화조직심편CK20염색방법,연구초저위직장암신보조치료조(21례)여직접수술조(23례)행Miles수술후적대체표본.결과 신보조치료조21례환자직장계막공검획림파결138매,기중전이림파결39매,미전이12매;7례위림파결암전이,2례위림파결미전이,6례위병리완전완해.직접수술조23례환자적직장계막공검획림파결415매,기중전이림파결169매,미전이59매;12례위림파결암전이,4례위림파결미전이.량조직장계막외대여전구적전이림파결분별점21.5％(11/51)여29.0％(49/169)、17.6％(9/51)여17.2％(29/169).좌골직장와전이림파결분별점해구총림파결적25.0％(3/12)여22.2％(8/36),해구림파결전이혹미전이자분별점총병례수적4.8％(1/21)여13.0％(3/23).결론 신보조치료영향초저위직장암구역림파결적전이여분포,신보조치료조항문괄약기루급교직접수술조현저강저,좌골직장와내겁소발생림파결전이,Miles수술작위초저위직장암신보조치료후표준술식적개치응중신평고.
Objective To investigate the lymph nodes distribution and metastatic pattern of the ultra-low rectal cancer after neoadjuvant therapy.Methods A total of 21 rectal cancer gross specimen after neoadjuvant therapy and 23 rectal cancer gross specimen without neoadjuvant therapy were investigated by whole mount section and tissue microarray techniques with CK20.All the patients were treated by abdominoperineal resection.Results There were 138 lymph nodes retrieved from the mesorectum in the neoadjuvant group including 39 metastatic lymph nodes and 12 micro-metastatic lymph nodes.Among these nodes,there were 7 rectal cancer cases with lymph nodes and 2 cases with micro-metastatic lymph nodes,and 6 cases had pathological complete remission.There were 415 lymph nodes retrieved from the mesorectum in the group without neoadjuvant therapy including 169 metastatic lymph nodes and 59 micro-metastatic lymph nodes.Among these nodes,there were 12 rectal cancer cases with lymph nodes and 4 cases with micro-metastatic lymph nodes.The proportions of metastatic lymph nodes in outer zone between the two groups were 21.5％ and 29.0％,and those in pre-zone were 17.6％ and 17.2％ respectively.The ratio of metastatic lymph nodes in ischiorectal fossa between the two groups were 25.0％ vs.22.2％ respectively.The rate of metastatic or micro-metastatic lymph nodes cases between the two groups were 4.8％ vs.13.0％ respectively.Conclusions The lymph nodes distribution and metastatic pattern of the ultra-low rectal cancer are affected by neoadjuvant therapy.The proportions of the anal sphincter invasion and metastatic or micro-metastatic lymph nodes in ischiorectal fossa are lower after neoadjuvant therapy.Abdominoperineal resection as the standard treatment of the ultra-low rectal cancer after neoadjuvant therapy should be re-evaluated.