【Abstract】ObjectiveTo study the distal intramural spread of rectal carcinoma, and provide evidence for modification of rectal carcinoma surgery. MethodsSixty patients with rectal carcinoma admitted to the first affiliated hospital of Chongqing university of medical science from November 2001 to October 2002 were included. The specimens were extended to its original size and shape by the fat clearing method. Mesenteric lymph nodes were dissected by using transillumination to examine metastases histologically, then a lymph nodes map was produced which including the site of the primary lesion, the vascular distribution, and the sites of dissected nodes. The specimen below the distal margin of the tumor was cut continuously with 0.5 cm interval then sectioned for histopathological examination. ResultsTumor spread to the distal intramural was observed in 11 of 60 patients (18.3%) with the range within 1.5 cm, of which less than 0.5 cm in 5 case, 5 cm to 1.0 cm in 2 cases, 1.0 cm to 1.5 cm in 4 cases. The tumor invasion was correlated with gross type, histological type and infiltrative depth, but not with sex, age, location of the tumor, size of the tumor, lymph nodes metastases and Dukes stage. Conclusion The range of distal mural excision should exceed 1.5 cm to tumor margin in radical surgery for rectal carcinoma. This rule should be emphasized for patients with poor cell differentiation and deep infiltration.
Objective To evaluate the outcome of pedicle graft of greater omentum and polypropylene mesh in reconstruction of large defect of abdominal wall caused by surgical incision. Methods From 1994 to 2004, 12 cases of large abdominal wall defects were repaired with pedicle graft of greater omentum and polypropylene mesh after removal of abdominal wall tumor; the defect sizes of abdominal wall ranged from 10 cm×7 cm to 25 cm×17 cm. Results The abdominal wall wound in 12 cases were healed by first intention. After a follow-up of 1 to 5 years, no complications of abdominal hernia, infection and intestine obstruction occurred in all patients. Conclusion It is reliable to repair abdominal wall defect caused by surgical incision with pedicle graft of greater omentum and polypropylene mesh instead of peritoneum.
【摘要】 目的 探讨Survivin表达在结直肠癌发生，转移中的作用及临床意义。 方法 2003年1月－2004年12月间采用免疫组织化学链霉菌抗生物素蛋白-过氧化物酶连结法测定58例结直肠癌、12例结直肠腺瘤和9例正常结肠组织中Survivin的表达水平，研究其与结直肠癌患者临床病理特征及预后的关系。 结果 Survivin蛋白在正常结直肠黏膜中不表达，而在结直肠腺瘤及结直肠癌组织中的表达均高于正常大肠黏膜，差异有统计学意义（Plt;0.05）。不同年龄、性别、浆膜浸润、淋巴结转移、远处转移、分化程度、Dukes分期等之间Survivin的表达差异均无统计学意义（Pgt;0.05）。Kaplan-Meier生存分析提示:Survivin表达阳性患者的5年生存率为51.2%，阴性者为90.9%，两组比较差异有统计学意义（Plt;0.05）。 结论 Survivin的异常表达参与了结直肠癌发生、发展的病理生理过程，对结直肠癌患者的治疗方式的选择、疗效和预后的评估方面具有重要的参考价值。【Abstract】 Objective To determine the expression of Survivin in the onset and metastasis of colorectal adenocarcinoma, and its clinical significance. Methods From January 2003 to December 2004, immunohistochemical staining, streptavidin-perosidase method, was used to detect the Survivin expression in 58 cases of colorectal carcinoma, 12 cases of colorectal adenoma, and 9 cases of normal tissues. Correlation between the expression of Survivin and clinicopathological factors in colorectal cancer was analyzed. Results Survivin was not expressed in normal colorectal tissues. The expression of Survivin in colorectal carcinoma and adenoma was significantly higher than that in norma1 colorectal tissues (Plt;0.05). There was no correlation of Survivin expression with such clinicopathologic factors as age, gender, serosa infiltration, lymph node metastasis, distal metastasis, differentiation level and Dukes stage (Pgt;0.05). The Kaplan-Meier survival analysis demonstrated that patients with Survivin-positive tumors had significantly poorer survival rate (51.2%) than those with Survivin-negative tumors (90.9%) (Plt;0.05). Conclusion Abnormal expression of Survivin plays an important role in carcinogenesis and progress of colorectal carcinoma and can be regarded as a good index for the choice of surgery, and assessment of clinical outcomes and prognosis for colorectal cancer patients.
Objective To evaluate branched-chain DNA (b-DNA) signal amplification and semi-quantitative (Sq) RT-PCR in detection of free cancer cells in peritoneal flushing fluid of colorectal cancer patients during surgery. Methods The CEA mRNA in peritoneal flushing fluid in 48 cases of colorectal cancer were detected by b-DNA and SqRT-PCR. Peritoneal flushing fluid cytology (PLC) was conformed simultaneously to detect the free cancer cells. The peritoneal flushing fluid of 12 cases with colorectal benign disease were taken as negative control, GAPDH mRNA as internal control. Results In colorectal cancer patients, positive rate of free cancer cells by bDNA and SqRT-PCR （43.8%, 31.3%） was higher than that by PLC （4.2%）. The relative quantitative expressions of CEA mRNA were related to the Dukes staging， depth invasion and differentiation degree (Plt;0.05)， but irrelevant to tumor size，the patients’ age and gender (Pgt;0.05).Conclusion Both b-DNA and SqRT-PCR technologies have advantages and disadvantages to detect free cancer cells in peritoneal flushing fluid， which are related to clinicopathological factors.