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Objective: cancer is one of the most common malignant tumor, accounting for about 60% of colorectal cancer, the incidence rate showed a rising trend. Surgery is the main treatment for cancer, but is still a certain rate of recurrence after radical surgery, how to reduce the local recurrence rate, improve the patient's quality of life, has been the concern of the surgeon. Total mesorectal excision (total mesorectal excision, TME) surgery widely principles, the local recurrence of rectal cancer was significantly lower. But these patients after curative resection is still a certain recurrence rate, reason, is not accurate clinical and pathological staging of the disease after surgery, the presence in the body of micro-metastases could not be found in a timely manner, phased assessment low, resulting in improper postoperative treatment options, as accurate staging of these cases, find very tiny occult metastatic lesions, reduce the transfer rate of missed diagnosis and as a basis for the development of rational postoperative comprehensive treatment program will be significantly improved survival and quality of life of these patients. Tumor micrometastasis generally refers to non-hematological malignancies in the development process, disseminated and lives in a small tumor foci in the lymphatic system, blood circulation, bone marrow, liver, lung and other tissues and organs, it can be a single tumor cells or independent tumor foci, no special blood supply, diameter lt; 2mm, often without any clinical manifestations, conventional inspection methods such as CT \\ MRI and pathological examination is difficult to find. Recurrence and metastasis of colorectal cancer is the main cause of death in patients with postoperative local tumor recurrence and metastasis in patients who underwent radical surgery, 50% of patients still die of Dukes A and B colorectal cancer patients after surgery is still a certain recurrence and metastasis rate, the reason may be associated with early colorectal cancer patients existed tumor micro-metastasis. In recent years, the mesorectal circumferential resection margin (circumferential resection margin, CRM) is increasingly people's attention, and more and more evidence to confirm a positive CRM is an important factor for local recurrence of rectal cancer. Pathological tissue sections can be objectively and accurately observe the cancer postoperative CRM. This method of pathological examination can be observed from the overall cancer metastases in the mesorectum orientation and its relationship with the primary tumor and the rectal wall, this method can accurately observe surgical margin status, to determine whether the CRM positive. Combined with immunohistochemical techniques, can be found in the circumferential resection margin of the tumor micro-metastases, so as to further improve the CRM-positive detection rate. In this study, HE staining and immunohistochemistry pathological tissue sections combined, to explore ways to further improve the CRM-positive detection rate, combined with the 43 patients with clinical data, the found CRM existence of the law, to guide clinical treatment. Method: 1.HE stained pathological tissue sections: slice through large organizations observed the relationship of the the CRM case with clinical and pathological data, and then used for statistical analysis. 2 immunohistochemistry: SP method, in accordance with the kit instructions dilution of mouse anti-human 1:80,1:80,1:40 CK20, CEA, Ki-67 monoclonal antibodies were used to detect the cancer system membrane micro-metastases, found CRM micro transfer. PBS instead of primary antibody as a negative control. Combined with clinical and pathological data related statistical analysis of the results. Results: 1.HE stained pathological tissue slice assay CRM positive rate was 25.58% (11/43). In which the degree of tumor differentiation, high the differentiated group CRM-positive rates were 0 (0/2), 20.59% (7/34), and in poorly differentiated group CRM positive rate as high as 57.14% (4/7), statistics The analysis revealed high in differentiated and poorly differentiated group there was a significant difference was statistically significant (p = 0.036 lt; 0.05), CRM positive rate differentiation group was higher than that highly differentiated group. Edge distance from the dentate line) in the location of the tumor (tumor ≤ 5cm set of CRM positive rate was 50.00% (7/14) higher than the GT; 5cm group CRM positive rate of 13.79% (4/29), statistical analysis The significant difference between the two groups (p = 0.035 lt; 0.05). CRM positive rate in the patient's sex, tumor gross type, surgical approach (open / laparoscopic) with no significant correlation (P gt; 0.05) Immunohistochemical results, CK20, CEA, Ki-67 slice assay CRM positive rates were 32.56% (14/43), 30.23% (13/43), 27.91% (12/43). In the degree of tumor differentiation, three indicators are confirmed, differentiated set of CRM positive rate lower than the poorly differentiated group, statistical analysis there was a significant difference (P lt; 0.05). The location of the tumor (tumor edge distance from the dentate line), three indicators showed lt; 5cm group CMI is higher than in the of ≥ 5cm group, statistically significant difference (P lt; 0.05). The three indicators of patient gender, tumor gross type, lymph node metastasis, surgical approach (open / laparoscopic) and CRM positive rate was no significant correlation (P GT; 0.05). 3 HE staining joint immunohistochemistry three indicators were detected in 20 cases of CRM-positive patients, the positive rate was 46.51% (20/43). HE staining, CK20, CEA, Ki-67 slice assay CRM positive rate was 25.58% (11/43), 32.56% (14/43), 30.23% (13/43), 27.91% (12/43) pairwise comparisons were not statistically significant (p = 0.56 GT; 0.05). Statistically HE staining, CK20, CEA, Ki-67 slice joint detection CRM-positive rate is higher than any of detection methods (p = 0.043 lt; 0.05). Conclusion: CRM-positive patients an important risk factor for local recurrence, clinicians concern. 2 pathological tissue sections can be very good observation CRM, patients should be routine examination. 3 HE staining and immunohistochemical CK20, CEA, Ki-67 three indicators combined detection of CRM positive rate is higher. 4 for the presence of CRM-positive patients, regardless of pathological staging sooner or later, should postoperative radiation therapy or chemotherapy. 5 degree of tumor differentiation, tumor location is an important factor affecting the CRM positive rate. 6 CRM positive rate with the patient's gender, tumor gross type of surgical approach (open / laparoscopic) no significant correlation.
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