本文選題：低位直腸癌 + 淋巴結(jié)轉(zhuǎn)移��； 參考：《廣西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:研究肛周組織淋巴分布及其回流情況,并探討其臨床意義。方法:收集符合篩選條件的2016年4月-2017年4月在廣西科大學(xué)第一附屬醫(yī)院行APR(直腸癌腹會陰聯(lián)合根治術(shù))患者15例,經(jīng)醫(yī)院倫理管理部門批準(zhǔn),患者簽字同意后,將15例患者分為ABC三組,每組各5例,對A組患者行APR術(shù)后標(biāo)本局部組織(肛門外括約肌)行免疫組化方法;對B組患者術(shù)中應(yīng)用吲哚菁綠注射淋巴示蹤技術(shù);對C組患者術(shù)前應(yīng)用低分子納米碳注射淋巴示蹤技術(shù)。分析各組實(shí)驗(yàn)結(jié)果,結(jié)合組織胚胎學(xué)、解剖學(xué)研究成果,綜合描述肛周淋巴分布及其回流情況并分析其臨床意義。結(jié)果:A組患者術(shù)后標(biāo)本中肛門外括約肌組織行免疫組化發(fā)現(xiàn)有淋巴管存在,但未發(fā)現(xiàn)有淋巴結(jié)組織。B組患者腫瘤下方肛管黏膜下層組織內(nèi)注入吲哚菁綠配制液后,熒光探頭掃描術(shù)中患者肛周、腹股溝區(qū)域皮膚及術(shù)后標(biāo)本,發(fā)現(xiàn)發(fā)出熒光的吲哚菁綠可隨淋巴液往上方、側(cè)方、下方回流,腹股溝區(qū)域及腸系膜主干血管旁有淋巴結(jié)強(qiáng)熒光顯影點(diǎn),肛門外括約肌及肛周脂肪組織內(nèi)無淋巴結(jié)強(qiáng)熒光顯影點(diǎn)。C組患者納米碳注入腫瘤下方肛管黏膜下層,術(shù)后標(biāo)本解剖可見腸系膜淋巴管及主干血管周圍有黑染淋巴結(jié),肛周脂肪組織、肛門外括約肌及各部間隙內(nèi)未見黑染及非黑染淋巴結(jié)。結(jié)論:低位直腸癌有下方淋巴結(jié)轉(zhuǎn)移可能,但是,肛門外括約肌及肛周脂肪組織內(nèi)只有淋巴管而未發(fā)現(xiàn)淋巴結(jié)組織存在,該部位發(fā)生腫瘤淋巴結(jié)轉(zhuǎn)移的可能性小,為低位直腸癌行ISR的手術(shù)方式提供了依據(jù)。
[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.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R735.37

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