• 1.南京軍區(qū)福州總醫(yī)院普通外科研究所（福州350025）;;
  • 2.第四軍醫(yī)大學(xué)附屬西京醫(yī)院胃腸外科（西安710032）;

目的 　觀察直腸癌組織及其遠(yuǎn)端黏膜組織中P53蛋白表達(dá)及微血管分布，并從分子病理學(xué)水平探討直腸癌的安全遠(yuǎn)側(cè)切緣。
方法 　對45例中低位直腸癌下緣進(jìn)行標(biāo)記，PET/CT檢查并結(jié)合半定量免疫組織化學(xué)方法檢測直腸癌及其遠(yuǎn)端黏膜組織中P53和CD34蛋白的表達(dá)。
結(jié)果 　直腸癌及其遠(yuǎn)端黏膜組織中均可見P53蛋白表達(dá)及微血管分布，直腸癌組織中P53蛋白表達(dá)及微血管密度(MVD)明顯高于直腸癌遠(yuǎn)端黏膜組織(P＜0.01)。直腸癌遠(yuǎn)端黏膜組織中P53蛋白表達(dá)及MVD隨著距離增大而減少，但有統(tǒng)計學(xué)意義的改變只在直腸癌遠(yuǎn)端1.5 cm內(nèi)。正常直腸組織中仍有P53蛋白表達(dá)和微血管分布。除直腸癌組織及其遠(yuǎn)端0.5 cm段黏膜組織中MVD與腫瘤直徑有關(guān)(P＜0.05)外，直腸癌及其遠(yuǎn)端黏膜組織中P53蛋白表達(dá)及MVD分布與腫瘤直徑、分期以及分化程度均無關(guān)。
結(jié)論 　從分子病理學(xué)角度說明2 cm的直腸癌遠(yuǎn)端長度是安全的遠(yuǎn)側(cè)切緣。

引用本文： 涂小煌,王為忠,王烈,黎成金,宋京翔,宋麗娜,趙春雷. 直腸癌及其遠(yuǎn)端黏膜P53和CD34的表達(dá)及意義. 中國普外基礎(chǔ)與臨床雜志, 2008, 15(9): 641-645. doi: 復(fù)制

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2. 　涂小煌， 王烈主編. 直腸癌全直腸系膜切除術(shù) [M]. 第1版. 福州： 福建科學(xué)技術(shù)出版社, 2006∶122～130.
3. 　Munro AJ, Lain S, Lane DP. P53 abnormalities and outcomes in colorectal cancer: a systematic review [Ｊ]. Br J Cancer， 2005; 92(3)∶434.
4. 　孫治君, 周鑫, 姚榛祥, 等. P-gp、nm23和p53聯(lián)合檢測判斷乳腺癌預(yù)后的價值 [Ｊ]. 中國普外基礎(chǔ)與臨床雜志, 2005; 12(3)∶244.
5. 　Hilska M, Collan YU, O Laine VJ, et al. The significance of tumor markers for proliferation and apoptosis in predicting survival in coloretal cancer [Ｊ]. Dis Colon Rectum, 2005; 48(12)∶2197.
6. 　Zhou XD, Yu JP, Chen HX, et al. Expression of cellular FLICE-inhibitory protein and its association with p53 mutation in colon cancer [Ｊ]. World J Gastroenterol, 2005; 11(16)∶2482.
7. 　Salmon JS, Lockhart AC, Berlin J. Anti-angiogenic treatment of gastrointestinal malignancies [Ｊ]. Cancer Invest, 2005; 23(8)∶712.
8. 　Uzzan B, Nicolas P, Cucherat M, et al. Microvessel density as a prognostic factor in women with breast cancer: a systematic review of the literature and meta-analysis [Ｊ]. Cancer Res, 2004; 64(9)∶2941.
9. 　張劍, 何生, 李茂德. 肝細(xì)胞癌中iNOS和p53蛋白的表達(dá)及其與腫瘤血管形成的關(guān)系 [Ｊ]. 中國普外基礎(chǔ)與臨床雜志, 2004; 11(5)∶396.
10. 　Famulski W, Sulkowska M, Wincewicz A, et al. P53 correlates positively with VEGF in preoperative sera of colorectal cancer patients [Ｊ]. Neoplasma, 2006; 53(1)∶43.
11. 　Kern A, Taubert H, Scheele J, et al. Association of p53 mutations, microvessel density and neoangiogenesis in pairs of colorectal cancers and corresponding liver metastases [Ｊ]. Int J Oncol, 2002; 21(2)∶243.
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14. 　Ngoi SS, Staiano-Coico L, Godwin TA, et al. Abnormal DNA ploidy and proliferative patterns in superficial colonic epithelium adjacent to colorectal cancer [Ｊ]. Cancer, 1990; 66(5)∶953.
15. 　潘志忠, 萬德森, 張昌卿, 等. 大切片P53免疫組化染色對判斷直腸癌遠(yuǎn)端擴(kuò)散長度的臨床意義 [Ｊ]. 癌癥, 2004; 23(10)∶1199.
16. 　范恩學(xué), 孫海俠, 李愛麗. 直腸癌旁移行黏膜P21 P53蛋白表達(dá)及其對保肛術(shù)的影響 [Ｊ]. 山西醫(yī)藥雜志, 2005; 34(8)∶667.
17. 　鄭國強(qiáng), 王怡, 陳香玲, 等. 直腸癌Dixon術(shù)后直腸下端切緣p53突變基因分析 [Ｊ]. 臨床腫瘤學(xué)雜志, 2000; 5(4)∶229.
18. 　鄧海軍, 李國新, 卿三華, 等. 直腸癌遠(yuǎn)側(cè)癌旁黏膜p53基因突變及其蛋白表達(dá) [Ｊ]. 實(shí)用癌癥雜志, 2003; 18(2)∶170.
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20. 　Karanjia ND, Schache DJ, North WR, et al. ‘Close shave’ in anterior resection [Ｊ]. Br J Surg, 1990; 77(5)∶510.
  1. 1. 　Jeong SY, Chessin DB, Guillem JG. Surgical treatment of rectal cancer: radical resection [Ｊ]. Surg Oncol Clin N Am， 2006; 15(1)∶95.
  2. 2. 　涂小煌， 王烈主編. 直腸癌全直腸系膜切除術(shù) [M]. 第1版. 福州： 福建科學(xué)技術(shù)出版社, 2006∶122～130.
  3. 3. 　Munro AJ, Lain S, Lane DP. P53 abnormalities and outcomes in colorectal cancer: a systematic review [Ｊ]. Br J Cancer， 2005; 92(3)∶434.
  4. 4. 　孫治君, 周鑫, 姚榛祥, 等. P-gp、nm23和p53聯(lián)合檢測判斷乳腺癌預(yù)后的價值 [Ｊ]. 中國普外基礎(chǔ)與臨床雜志, 2005; 12(3)∶244.
  5. 5. 　Hilska M, Collan YU, O Laine VJ, et al. The significance of tumor markers for proliferation and apoptosis in predicting survival in coloretal cancer [Ｊ]. Dis Colon Rectum, 2005; 48(12)∶2197.
  6. 6. 　Zhou XD, Yu JP, Chen HX, et al. Expression of cellular FLICE-inhibitory protein and its association with p53 mutation in colon cancer [Ｊ]. World J Gastroenterol, 2005; 11(16)∶2482.
  7. 7. 　Salmon JS, Lockhart AC, Berlin J. Anti-angiogenic treatment of gastrointestinal malignancies [Ｊ]. Cancer Invest, 2005; 23(8)∶712.
  8. 8. 　Uzzan B, Nicolas P, Cucherat M, et al. Microvessel density as a prognostic factor in women with breast cancer: a systematic review of the literature and meta-analysis [Ｊ]. Cancer Res, 2004; 64(9)∶2941.
  9. 9. 　張劍, 何生, 李茂德. 肝細(xì)胞癌中iNOS和p53蛋白的表達(dá)及其與腫瘤血管形成的關(guān)系 [Ｊ]. 中國普外基礎(chǔ)與臨床雜志, 2004; 11(5)∶396.
  10. 10. 　Famulski W, Sulkowska M, Wincewicz A, et al. P53 correlates positively with VEGF in preoperative sera of colorectal cancer patients [Ｊ]. Neoplasma, 2006; 53(1)∶43.
  11. 11. 　Kern A, Taubert H, Scheele J, et al. Association of p53 mutations, microvessel density and neoangiogenesis in pairs of colorectal cancers and corresponding liver metastases [Ｊ]. Int J Oncol, 2002; 21(2)∶243.
  12. 12. 　Boxer GM, Tsiompanou E, Levine T, et al. Immunohistochemical expression of vascular endothelial growth factor and microvessel counting as prognostic indicators in node-negative colorectal cancer [Ｊ]. Tumour Biol, 2005; 26(1)∶1.
  13. 13. 　Lebe B, Sarioglu S, Skmen S, et al. The clinical significance of p53, p21, and p27 expressions in rectal carcinoma [Ｊ]. Appl Immunohistochem Mol Morphol, 2005; 13(1)∶38.
  14. 14. 　Ngoi SS, Staiano-Coico L, Godwin TA, et al. Abnormal DNA ploidy and proliferative patterns in superficial colonic epithelium adjacent to colorectal cancer [Ｊ]. Cancer, 1990; 66(5)∶953.
  15. 15. 　潘志忠, 萬德森, 張昌卿, 等. 大切片P53免疫組化染色對判斷直腸癌遠(yuǎn)端擴(kuò)散長度的臨床意義 [Ｊ]. 癌癥, 2004; 23(10)∶1199.
  16. 16. 　范恩學(xué), 孫海俠, 李愛麗. 直腸癌旁移行黏膜P21 P53蛋白表達(dá)及其對保肛術(shù)的影響 [Ｊ]. 山西醫(yī)藥雜志, 2005; 34(8)∶667.
  17. 17. 　鄭國強(qiáng), 王怡, 陳香玲, 等. 直腸癌Dixon術(shù)后直腸下端切緣p53突變基因分析 [Ｊ]. 臨床腫瘤學(xué)雜志, 2000; 5(4)∶229.
  18. 18. 　鄧海軍, 李國新, 卿三華, 等. 直腸癌遠(yuǎn)側(cè)癌旁黏膜p53基因突變及其蛋白表達(dá) [Ｊ]. 實(shí)用癌癥雜志, 2003; 18(2)∶170.
  19. 19. 　Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery——the clue to pelvic recurrence? [Ｊ]. Br J Surg, 1982; 69(10)∶613.
  20. 20. 　Karanjia ND, Schache DJ, North WR, et al. ‘Close shave’ in anterior resection [Ｊ]. Br J Surg, 1990; 77(5)∶510.