• 1.解放軍第三二三醫(yī)院普外科（西安710054）;;
  • 2.第一軍醫(yī)大學(xué)南方醫(yī)院普外科（廣州510515）;

【摘要】目的以CEA mRNA為標(biāo)記物，應(yīng)用RT-PCR技術(shù)檢測(cè)直腸癌在直腸系膜的播散范圍，以探討直腸癌根治術(shù)直腸系膜的合理切除范圍。
方法40例直腸癌全系膜切除的手術(shù)標(biāo)本，取不同距離的直腸系膜以CEA mRNA為標(biāo)記物，應(yīng)用RT-PCR技術(shù)檢測(cè)其有無(wú)癌轉(zhuǎn)移。
結(jié)果在40例病例中發(fā)現(xiàn)直腸系膜有癌播散者9例（22.5%），播散最遠(yuǎn)距離在腫瘤下緣下4 cm。直腸癌在直腸系膜的播散與Dukes分期、腫瘤浸潤(rùn)腸壁深度、腫瘤分化程度及腫瘤分型相關(guān)（P＜0.05），與腫瘤大小及CEA水平無(wú)明顯相關(guān)性(P gt;0.05)。
結(jié)論直腸癌根治術(shù)中距腫瘤下緣5 cm范圍是直腸系膜的安全切緣。

引用本文： 王小林,卿三華,黃祥成,宋京翔,吳承堂. RT-PCR檢測(cè)直腸癌在直腸系膜的播散范圍及臨床意義. 中國(guó)普外基礎(chǔ)與臨床雜志, 2005, 12(1): 29-32. doi: 復(fù)制

1. Reynolds JV, Joyce WP, Dolan J, et al. Pathological evidence in support of total mesorectal excision in the management of rectal cancer [Ｊ]. Br J Surg, 1996; 83(8)∶1112.
2. Scott N, Jackson P, alJaberi T, et al. Total mesorectal excision and local recurrence: a study of tumour spread in the mesorectum distal to rectal cancer [Ｊ]. Br J Surg， 1995; 82(8)∶1031.
3. Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgerythe clue to pelvic recurrence? [Ｊ]. Br J Surg，1982; 69(10)∶613.
4. McCall JL, Cox MR, Wattchow DA. Analysis of local recurrence rates after surgery alone for rectal cancer [Ｊ]. Int J Colorectal Dis， 1995; 10(3)∶126.
5. Leather AJ, Gallegos NC, Kocjan G, et al. Detection and enumeration of circulating tumour cells in colorectal cancer [Ｊ]. Br J Surg， 1993; 80(6)∶777.
6. 谷志遠(yuǎn). 現(xiàn)代醫(yī)學(xué)分子生物學(xué) [M]. 北京： 人民軍醫(yī)出版社， 1998∶430～433.
7. Miyake Y, Yamamoto H, Fujiwara Y, et al. Extensive micrometastases to lymph nodes as a marker for rapid recurrence of colorectal cancer: a study of lymphatic mapping [Ｊ]. Clin Cancer Res， 2001; 7(5)∶1350.
8. Bilchik AJ, Saha S, Wiese D, et al. Molecular staging of early colon cancer on the basis of sentinel node analysis: a multicenter phase II trial [Ｊ]. J Clin Oncol， 2001; 19(4)∶1128.
9. Futamura M, Takagi Y, Koumura H, et al. Spread of colorectal cancer micrometastases in regional lymph nodes by reverse transcriptasepolymerase chain reactions for carcinoembryonic antigen and cytokeratin 20 [Ｊ]. J Surg Oncol， 1998; 68(1)∶34.
10. Datta YH, Adams PT, Drobyski WR, et al. Sensitive detection of occult breast cancer by the reversetranscriptase polymerase chain reaction [Ｊ]. J Clin Oncol， 1994; 12(3)∶475.
11. Adam IJ, Mohamdee MO, Martin IG, et al. Role of circumferential margin involvement in the local recurrence of rectal cancer [Ｊ]. Lancet， 1994; 344(8924)∶707.
12. Quirke P, Durdey P, Dixon MF, et al. Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Histopathological study of lateral tumour spread and surgical excision [Ｊ]. Lancet，1986; 2(8514)∶996.
13. Tocchi A, Mazzoni G, Lepre L, et al. Total mesorectal excision and low rectal anastomosis for the treatment of rectal cancer and prevention of pelvic recurrences [Ｊ]. Arch Surg， 2001; 136(2)∶216.
  1. 1. Reynolds JV, Joyce WP, Dolan J, et al. Pathological evidence in support of total mesorectal excision in the management of rectal cancer [Ｊ]. Br J Surg, 1996; 83(8)∶1112.
  2. 2. Scott N, Jackson P, alJaberi T, et al. Total mesorectal excision and local recurrence: a study of tumour spread in the mesorectum distal to rectal cancer [Ｊ]. Br J Surg， 1995; 82(8)∶1031.
  3. 3. Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgerythe clue to pelvic recurrence? [Ｊ]. Br J Surg，1982; 69(10)∶613.
  4. 4. McCall JL, Cox MR, Wattchow DA. Analysis of local recurrence rates after surgery alone for rectal cancer [Ｊ]. Int J Colorectal Dis， 1995; 10(3)∶126.
  5. 5. Leather AJ, Gallegos NC, Kocjan G, et al. Detection and enumeration of circulating tumour cells in colorectal cancer [Ｊ]. Br J Surg， 1993; 80(6)∶777.
  6. 6. 谷志遠(yuǎn). 現(xiàn)代醫(yī)學(xué)分子生物學(xué) [M]. 北京： 人民軍醫(yī)出版社， 1998∶430～433.
  7. 7. Miyake Y, Yamamoto H, Fujiwara Y, et al. Extensive micrometastases to lymph nodes as a marker for rapid recurrence of colorectal cancer: a study of lymphatic mapping [Ｊ]. Clin Cancer Res， 2001; 7(5)∶1350.
  8. 8. Bilchik AJ, Saha S, Wiese D, et al. Molecular staging of early colon cancer on the basis of sentinel node analysis: a multicenter phase II trial [Ｊ]. J Clin Oncol， 2001; 19(4)∶1128.
  9. 9. Futamura M, Takagi Y, Koumura H, et al. Spread of colorectal cancer micrometastases in regional lymph nodes by reverse transcriptasepolymerase chain reactions for carcinoembryonic antigen and cytokeratin 20 [Ｊ]. J Surg Oncol， 1998; 68(1)∶34.
  10. 10. Datta YH, Adams PT, Drobyski WR, et al. Sensitive detection of occult breast cancer by the reversetranscriptase polymerase chain reaction [Ｊ]. J Clin Oncol， 1994; 12(3)∶475.
  11. 11. Adam IJ, Mohamdee MO, Martin IG, et al. Role of circumferential margin involvement in the local recurrence of rectal cancer [Ｊ]. Lancet， 1994; 344(8924)∶707.
  12. 12. Quirke P, Durdey P, Dixon MF, et al. Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Histopathological study of lateral tumour spread and surgical excision [Ｊ]. Lancet，1986; 2(8514)∶996.
  13. 13. Tocchi A, Mazzoni G, Lepre L, et al. Total mesorectal excision and low rectal anastomosis for the treatment of rectal cancer and prevention of pelvic recurrences [Ｊ]. Arch Surg， 2001; 136(2)∶216.