直肠癌下切缘收缩性研究

发布时间：2018-06-06 06:47

本文选题：直肠癌 + 直肠癌全系膜切除术　；参考：《大连医科大学》2017年硕士论文

【摘要】：目的:直肠癌下切缘直接关系到手术是否做到根治,患者术后生活质量及远期生存率。临床医生及专家学者对安全下切缘问题进行过大量研究,但是由于直肠在不同状态下具有收缩性,因此术中下切缘长度与术后下切缘长度存在差异。因此我们做此研究,旨在:1、对直肠癌前切除术标本在不同状态进行测量,研究其变化规律;2根据直肠癌标本在不同状态下变化规律,为临床上判断合适下切缘长度提供依据。方法:选择于本院行直肠癌根治术且临床上无远处转移的患者30例,患者术前检查均无明显心、肺功能异常,均能耐受手术。对每例直肠癌标本在肿瘤上方至近切缘下方之间沿直肠纵轴任选取两点并用手术线打线结做好标记,然后在不同状态下进行测量两线结间的肠段长度:(1)术中游离直肠;(2)新鲜离体直肠标本(标本离体后即刻测量);(3)离体30min后直肠标本;(4)甲醛固定12-24h后直肠。通过测得直肠在不同状态下两标记点间肠段长度,计算肠段在不同状态下的收缩率。结果:1、术中直肠两标记点间肠段长度与离体新鲜直肠标本中两标记点间肠段肠长度、离体30min后直肠标本中两标记点间的肠段长度及甲醛固定后直肠标本中两标记点间的肠段长度其均值分别为:4.86±1.52cm,3.77±1.22cm,3.16±1.12cm,2.54±0.86cm。经单因素方差分析表明其均数有显著差异(P0.01),不同状态下直肠收缩比率分别为:(1)新鲜离体标本两标记点间肠段长度/术中标本两标记间肠段长度=66.67%-88.89%,平均收缩比率为77.59%;(2)离体30min后标本两标记点间肠段长度/术中标本两标记间肠段长度=58.46%-75.71%,平均收缩比率为65.45%;(3)甲醛固定后标本两标记点间肠段长度/术中直肠标本两标记点间肠段长度=38.70%-66.66%,平均收缩比率为52.25%。2两标记点间肠段长度取任意值,通过所测得数值发现:两标记点间肠段长度与肠管收缩性无明显关系(R2=0.0034)。即实验过程中所取两线结间肠段长度对实验无明显影响。结论:1.通过研究发现直肠下切缘在不同状态下具有收缩性,标本经甲醛固定后相对于术中标本收缩了47.73%,收缩了接近一半。2.对直肠癌根治术肿瘤下切缘的判断应考虑到直肠的收缩性,从而得到真正安全的下切缘。
[Abstract]:Objective: the lower margin of rectal cancer is directly related to the radical operation, postoperative quality of life and long-term survival rate. Clinicians and experts have done a lot of research on the safe incisal margin, but due to the contraction of the rectum in different states, the length of the lower incisor is different from that of the postoperative incisor. Therefore, we do this study in order to measure the different states of the specimens of anterior resection of rectal cancer at 1: 1, and to study the law of change. 2. According to the changes of rectal cancer specimens in different states, we can provide the basis for judging the appropriate length of the lower margin in clinic. Methods: 30 patients with rectal cancer underwent radical resection and no distant metastasis were performed in our hospital. Two points along the longitudinal axis of rectum were selected in each case of rectal cancer from the top of the tumor to the lower part of the proximal incisal margin. Then the length of intestinal segment between the two lines was measured in different states (1: 1) the free rectum 2) fresh rectal specimens (measured immediately after 30min) were fixed with formaldehyde 12-24 h after rectal fixation. The length of the intestinal segment between the two labeled points in different states was measured and the contraction rate of the intestinal segment in different states was calculated. Results: 1. The length of the intestinal segment between the two marked points in the rectum and that in the fresh rectal specimen in vitro, the length of the intestinal segment between the two marked points in the operation was compared with that of the fresh rectal specimen. The average length of the intestinal segment between the two labeling points in isolated rectal specimens after 30min and between the two labeled points in the rectal specimens fixed with formaldehyde was 3.77 卤1.22 cm ~ (-1) and 2.54 卤0.86 cm ~ (-1) respectively. The single factor analysis of variance showed that there was a significant difference in the mean of rectal contraction ratio between the two marked points in vitro and the length of the intestinal segment between the two marks in the operation. The average contraction ratio was 66.67 -88.89. The average contraction ratio of the two points was 6. 67-88. 89%, and the ratio of rectum contraction was 1: 1, respectively. The average contractile ratio was 6. 67-88. 89%. 77.59A) after 30min in vitro, the length of the intestinal segment between the two labeled points was 58.46-75.71 and the average contraction ratio was 65.45 / 3) the length of the intestinal segment between the two labeled points in the specimens was fixed by formaldehyde / the length of the intestinal segment between the two marked points in the rectal specimen during operation was 58.46-75.71. The average contraction ratio was 65.45 / 3) after formalin fixation, the length of the intestinal segment between the two labeling points of the specimen was fixed by formaldehyde. The average contraction ratio was 52.25.2 the length of the intestinal segment between the two marked points. It was found that there was no significant relationship between the length of intestinal segment and the contractility of intestinal tract between the two labeled points. That is to say, the length of the intestinal segment between the two lines has no obvious effect on the experiment. Conclusion 1. It was found that the lower rectal incisal margin had contractility in different states. The specimen was fixed with formaldehyde and contracted 47.73 and nearly half. 2. To judge the lower margin of rectal cancer after radical resection, we should consider the constriction of rectum so as to obtain a truly safe margin.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.37

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