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目的通过改良脂肪清除技术的应用,对直肠癌标本淋巴结转移情况进行准确分析,为直肠全系膜切除术提供临床病理学依据。方法研究组选2003—2005年的中低位直肠癌33例,对照组选取50名中低位直肠癌病例。研究组术后直肠标本通过改良脂肪清除技术处理后记录检出淋巴结数量、直径和转移情况。对照组标本采用常规方法检测。结果研究组33例共检出淋巴结1035枚,其中淋巴结直径≥5 mm 529枚,＜5 mm 506枚,平均淋巴结检出数目为31．36枚/人。20例发现存在淋巴结转移,共检出132枚淋巴结有肿瘤转移,其中淋巴结直径≥5 mm 75枚,＜5 mm 57枚。研究组淋巴结总检出数以及转移淋巴结检出数较对照组明显增多,特别是直径＜5 mm淋巴结检出数目明显增加。结论改良脂肪清除技术使直肠癌全系膜切除术后标本淋巴结检出数目明显增加。常规病理检测评价为T3N0(但淋巴结检出总数＜12枚)的病例,应用改良脂肪清除技术处理标本,可获得更多的淋巴结检出数量,有助于获得更为准确的病理评价、指导术后辅助治疗。
Objective To improve the diagnosis of lymph node metastasis in rectal cancer through the application of modified fat removal technique and provide a clinicopathological basis for total mesorectal excision. Methods The study group selected 33 cases of low and middle rectal cancer from 2003 to 2005 and 50 cases of low and middle rectal cancer from the control group. The postoperative rectal specimens of the study group were recorded by the modified fat removal technique to record the number, diameter and metastasis of the lymph nodes. Control samples were detected by routine methods. Results A total of 1035 lymph nodes were found in 33 cases of the study group, including 529 lymph nodes ≥5 mm in size and 506 in <5 mm. The average number of lymph nodes detected was 31.36 pieces / person. Twenty cases were found to have lymph node metastasis. A total of 132 lymph node metastases were detected, of which 75 were ≥5 mm in diameter and 57 were <5 mm in size. The total number of lymph nodes and the number of metastatic lymph nodes in study group were significantly higher than those in control group, especially the number of lymph nodes with diameter <5 mm was significantly increased. Conclusion The modified fat removal technique can significantly increase the number of lymph nodes detected after total mesorectal excision of rectal cancer. Routine pathological evaluation of T3N0 (but the total number of lymph nodes were <12) cases, the application of modified fat removal technique to deal with specimens, can get more number of lymph node detection, help to obtain more accurate pathological evaluation, guidance After adjuvant therapy.