肛门周围淋巴分布的描述及其临床意义分析

发布时间：2018-05-19 00:14

本文选题：低位直肠癌 + 淋巴结转移　；参考：《广西医科大学》2017年硕士论文

【摘要】：目的:研究肛周组织淋巴分布及其回流情况,并探讨其临床意义。方法:收集符合筛选条件的2016年4月-2017年4月在广西科大学第一附属医院行APR(直肠癌腹会阴联合根治术)患者15例,经医院伦理管理部门批准,患者签字同意后,将15例患者分为ABC三组,每组各5例,对A组患者行APR术后标本局部组织(肛门外括约肌)行免疫组化方法;对B组患者术中应用吲哚菁绿注射淋巴示踪技术;对C组患者术前应用低分子纳米碳注射淋巴示踪技术。分析各组实验结果,结合组织胚胎学、解剖学研究成果,综合描述肛周淋巴分布及其回流情况并分析其临床意义。结果:A组患者术后标本中肛门外括约肌组织行免疫组化发现有淋巴管存在,但未发现有淋巴结组织。B组患者肿瘤下方肛管黏膜下层组织内注入吲哚菁绿配制液后,荧光探头扫描术中患者肛周、腹股沟区域皮肤及术后标本,发现发出荧光的吲哚菁绿可随淋巴液往上方、侧方、下方回流,腹股沟区域及肠系膜主干血管旁有淋巴结强荧光显影点,肛门外括约肌及肛周脂肪组织内无淋巴结强荧光显影点。C组患者纳米碳注入肿瘤下方肛管黏膜下层,术后标本解剖可见肠系膜淋巴管及主干血管周围有黑染淋巴结,肛周脂肪组织、肛门外括约肌及各部间隙内未见黑染及非黑染淋巴结。结论:低位直肠癌有下方淋巴结转移可能,但是,肛门外括约肌及肛周脂肪组织内只有淋巴管而未发现淋巴结组织存在,该部位发生肿瘤淋巴结转移的可能性小,为低位直肠癌行ISR的手术方式提供了依据。
[Abstract]:Objective: to study the lymphatic distribution of perianal tissue and its clinical significance. Methods: fifteen patients with APR (combined abdominal perineal resection) were collected from April 2016 to April 2017 in the first affiliated Hospital of Guangxi University of Science and Technology. Fifteen patients were divided into three groups: ABC group (n = 5), group A (n = 5). Low molecular nano carbon injection lymphatic tracer technique was used in group C before operation. The distribution of perianal lymphoid and its reflux were described synthetically and its clinical significance was analyzed by analyzing the experimental results of each group combined with the results of histologic and anatomic studies. Results lymphatic vessels were found in the external anal sphincter tissue of group A after operation, but there were no lymphatic vessels in the submucous tissue of the anus of group B. after the injection of indocyanine green into the submucous tissue of the anus under the tumor, there were no lymphatic vessels in the external anal sphincter. The skin of perianal and inguinal regions and postoperative specimens were scanned by fluorescence probe. The fluorescent indocyanine green was found to flow back to the upper side and lower part of lymphatic fluid. In the inguinal region and the main mesenteric vessels, there were strong fluorescent lymph node spots in the lymph nodes. In group C, there were no strong fluorescent lymph nodes in the external anal sphincter and perianal adipose tissue. In group C, nano-carbon was injected into the submucous layer of the anal canal beneath the tumor. The lymph nodes around the mesenteric lymphatic vessels and main vessels were black stained lymph nodes, perianal adipose tissue, external anal sphincter and the space of all parts were not seen black stained and non-stained lymph nodes. Conclusion: lower lymph node metastasis is possible in low rectal cancer. However, there are only lymphatic vessels in the external anal sphincter and perianal adipose tissue, but no lymph node tissue. It provides the basis for the operation of ISR in low rectal cancer.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.37

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