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目的 评价血吸虫病直肠腺癌全部直肠切除结肠肛门吻合术后显微镜下的远侧端肠壁内肿瘤扩散的频率及其预后因素之间的关系。 方法 对 5 5例低位血吸虫病直肠腺癌患者进行体检并测量其 Dukes分期、肿瘤直径、切除肿瘤的远侧端边缘距离、浸润直肠周围脂肪组织的深度、淋巴结受侵的状况、肿瘤浸润血管和神经分枝情况以及远侧端肠壁粘膜下层或肌层内扩散的程度。结果 40 .0 %的患者远侧端肠壁内肿瘤扩散 ,其中 77.3%者为中晚期肿瘤患者 ,17例淋巴结转移 ,5例无淋巴结转移 ,肠壁内淋巴管受侵 12例 ,会阴部受侵 11例 ,肠壁神经分枝受侵 16例。术后远侧端肠壁肿瘤残留 3例。远侧端肠壁内肿瘤扩散者中肿瘤直径小于 10 mm者 2例 ,11～ 40 mm者 6例 ,大于 40 mm者 14例。 结论 低位血吸虫病直肠腺癌患者全部直肠切除结肠肛门吻合术后远侧肠壁内肿瘤扩散与肿瘤大小 (超过 40 mm)、直肠周围组织浸润、多发淋巴结转移、肠内壁淋巴管肿瘤栓子及神经分枝的肿瘤浸润密切相关
Objective To evaluate the relationship between the frequency of tumor spread in distal end intestinal wall under microscope and its prognostic factors after all the patients underwent rectal resection and colorectal anastomosis of schistosomiasis. Methods Fifty-five patients with rectal adenocarcinoma of low schistosomiasis were examined by physical examination and Dukes staging, tumor diameter, distance from the distal end of resected tumor, depth of adipose tissue infiltration and rectal invasion, invasion of lymph nodes, Nerve branching as well as the extent to which distal distal mucosa or myometrium diffuse. Results 40.0% of patients had distal distal gut wall tumor spread, of which 77.3% were advanced cancer patients, 17 cases of lymph node metastasis, 5 cases of non-lymph node metastasis, intestinal wall lymphatic invasion in 12 cases, perineal Invasion in 11 cases, 16 cases of intestinal wall invasion of nerve branches. Postoperative distal side of the intestinal wall tumor residue in 3 cases. In the distal end of the intestinal wall tumor spread in tumor diameter less than 10 mm in 2 cases, 11 ~ 40 mm in 6 cases, more than 40 mm in 14 cases. Conclusions All patients with rectal adenocarcinoma of the low schistosomiasis had colorectal anorectal anastomosis, and the tumor spread and tumor size (more than 40 mm) in the distal intestine and anus, the infiltration of the tissues around the rectum, multiple lymph node metastasis, lymphatic vessel emboli and nerves Branched tumor invasion is closely related