本文選題：直腸癌 + 直腸癌全系膜切除術(shù)　； 參考：《大連醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:直腸癌下切緣直接關(guān)系到手術(shù)是否做到根治,患者術(shù)后生活質(zhì)量及遠(yuǎn)期生存率。臨床醫(yī)生及專家學(xué)者對安全下切緣問題進(jìn)行過大量研究,但是由于直腸在不同狀態(tài)下具有收縮性,因此術(shù)中下切緣長度與術(shù)后下切緣長度存在差異。因此我們做此研究,旨在:1、對直腸癌前切除術(shù)標(biāo)本在不同狀態(tài)進(jìn)行測量,研究其變化規(guī)律;2根據(jù)直腸癌標(biāo)本在不同狀態(tài)下變化規(guī)律,為臨床上判斷合適下切緣長度提供依據(jù)。方法:選擇于本院行直腸癌根治術(shù)且臨床上無遠(yuǎn)處轉(zhuǎn)移的患者30例,患者術(shù)前檢查均無明顯心、肺功能異常,均能耐受手術(shù)。對每例直腸癌標(biāo)本在腫瘤上方至近切緣下方之間沿直腸縱軸任選取兩點并用手術(shù)線打線結(jié)做好標(biāo)記,然后在不同狀態(tài)下進(jìn)行測量兩線結(jié)間的腸段長度:(1)術(shù)中游離直腸;(2)新鮮離體直腸標(biāo)本(標(biāo)本離體后即刻測量);(3)離體30min后直腸標(biāo)本;(4)甲醛固定12-24h后直腸。通過測得直腸在不同狀態(tài)下兩標(biāo)記點間腸段長度,計算腸段在不同狀態(tài)下的收縮率。結(jié)果:1、術(shù)中直腸兩標(biāo)記點間腸段長度與離體新鮮直腸標(biāo)本中兩標(biāo)記點間腸段腸長度、離體30min后直腸標(biāo)本中兩標(biāo)記點間的腸段長度及甲醛固定后直腸標(biāo)本中兩標(biāo)記點間的腸段長度其均值分別為:4.86±1.52cm,3.77±1.22cm,3.16±1.12cm,2.54±0.86cm。經(jīng)單因素方差分析表明其均數(shù)有顯著差異(P0.01),不同狀態(tài)下直腸收縮比率分別為:(1)新鮮離體標(biāo)本兩標(biāo)記點間腸段長度/術(shù)中標(biāo)本兩標(biāo)記間腸段長度=66.67%-88.89%,平均收縮比率為77.59%;(2)離體30min后標(biāo)本兩標(biāo)記點間腸段長度/術(shù)中標(biāo)本兩標(biāo)記間腸段長度=58.46%-75.71%,平均收縮比率為65.45%;(3)甲醛固定后標(biāo)本兩標(biāo)記點間腸段長度/術(shù)中直腸標(biāo)本兩標(biāo)記點間腸段長度=38.70%-66.66%,平均收縮比率為52.25%。2兩標(biāo)記點間腸段長度取任意值,通過所測得數(shù)值發(fā)現(xiàn):兩標(biāo)記點間腸段長度與腸管收縮性無明顯關(guān)系(R2=0.0034)。即實驗過程中所取兩線結(jié)間腸段長度對實驗無明顯影響。結(jié)論:1.通過研究發(fā)現(xiàn)直腸下切緣在不同狀態(tài)下具有收縮性,標(biāo)本經(jīng)甲醛固定后相對于術(shù)中標(biāo)本收縮了47.73%,收縮了接近一半。2.對直腸癌根治術(shù)腫瘤下切緣的判斷應(yīng)考慮到直腸的收縮性,從而得到真正安全的下切緣。
[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 鹵1.22 cm ~ (-1) and 2.54 鹵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.
【學(xué)位授予單位】：大連醫(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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本文編號：1985650