摘要
目的 研究肝癌微转移的分布规律 ,为手术切除范围提供参考。方法 选择无临床转移灶的肝细胞癌病例 ,取切缘较充分的手术切除标本 36例 ,将其瘤周组织划分为近端区域和远端区域 ,制成病理大切片。在距原发灶边缘 0 .5 ,1.0 ,2 .0cm分别做 3条分界线 (L0 .5、L1.0 、L2 .0 ) ,把近端和远端区域的瘤周组织由内向外划分出 6组条带 (Zp0 .5、Zp1.0 、Zp2 .0 和Zd0 .5、Zd1.0 、Zd2 .0 )。分析微转移的扩散距离和各组条带的微转移密度 (Dp0 .5、Dp1.0 、Dp2 .0 和Dd0 .5、Dd1.0 、Dd2 .0 )。结果 检出的微转移 72 .5 %(111/15 3)是门静脉微癌栓。在 6 6 .7% (2 4/36 )的标本中检出了微转移 ,其中 91.7% (2 2 /2 4)的标本远端最大扩散距离 <3cm。在近端区域的特定分析中 ,92 .3% (12 /13)的标本近端最大扩散距离 <1.5cm。微转移密度比较 :Dp0 .5>Dp1.0 >Dp2 .0 ,Dd0 .5>Dd1.0 >Dd2 .0 ,Dd1.0 >Dp1.0 ,Dd2 .0 >Dp2 .0 ,差异有显著性。结论 (1)肝癌微转移主要以门静脉微癌栓的形式存在 ;(2 )距原发灶越远 ,微转移发生率越低 ;(3)在距原发灶 0 .5cm以外的范围 ,微转移在近端区域的发生率比在远端区域的低 ;(4 )对于无临床转移灶的患者 ,在远端切除瘤周组织范围达到 3cm ,在近端切除范围达到 1.5cm ,可能有助?
Objective To study the micrometastasis distribution in liver tissue surrounding hepatocellular carcinoma (HCC), and provide reference for appropriate surgical safety margin. Methods Thirty-six patients with HCC but without clinical metastasis underwent hepatectomy. Their specimens showing ample surgical margin were made into giant sections. Tumor micrometastasis in liver tissue around the primary tumor were examined microscopically. In each specimen, the surrounding tissue was divided into proximal(p) and distal(d) areas. In either area, three lines of demarcation 0.5 cm, 1.0 cm, and 2.0 cm away from the margin of the primary tumor were designated as L 0.5 , L 1.0 and L 2.0 . Therefore, the surrounding tissue was divided into six zones -- Z p0.5 , Z p1.0 , Z p2.0 and Z d0.5 , Z d1.0 , Z d2.0 . The maximum micrometastasis spread distance (MMSD) and density (D p0.5 , D p1.0 , D p2.0 and D d0.5 , D d1.0 , D d2.0 ) in each zone were analyzed after search for microstastis in the giant sections. Results 72.5% (111/153) micrometastases were found in form of microscopic tumor emboli. Their spread distance could be up to 6.1 cm. In 66.7% (24/36) specimens, micrometastases were found in the surrounding tissue. In 91.7% (22/24) of them, the distal MMSD was less than 3 cm. The proximal MMSD was less than 1.5 cm in 92.3% (12/13). The comparison of micrometastasis density in the different zones were D d0.5 >D d1.0 >D d 2.0 ; D p0.5 >D p1.0 >D p2.0 ; D d1.0 >D p1.0 ; D d2.0 >D p2.0 with significant differences. Conclusion (1)Micrometastases of HCC exist mainly in form of microscopic tumor emboli, (2)The longer the distance from the primary focus, the lower the micrometastasis incidence, (3) In zones more than 0.5 cm away from the primary focus, tumor micrometastasis incidence is significantly lower in the proximal zones than that in the distal zones and (4) For HCC patients without clinical metastasis, a surgical margin of 3 cm wide in the distal area and 1.5 cm wide in the proximal area may reduce the rate of postoperative recurrence.
出处
《中华肿瘤杂志》
CAS
CSCD
北大核心
2002年第3期257-260,共4页
Chinese Journal of Oncology
基金
国家科委九五攻关课题 ( 96 90 7 0 3 0 2 )
广东省医学科学技术研究基金 (B19990 70 )
关键词
肝细胞癌
周围微小转移分布
研究
肝肿瘤
肝切除术
肿瘤转移
Liver neoplasms / surgery
Carcinoma, hepatocellular/surgery
Hepatectomy
Neoplasm metastasis
