于雪姣 张芳 周磊

[摘要] 目的 探討弹力纤维染色在判断结直肠癌脏层腹膜弹力层侵犯和血管侵犯中的应用价值及临床意义。方法 选取2013年1月～2016年12月山东省青岛市市立医院结直肠癌组织学标本75例，采用常规HE染色和地衣红弹力纤维染色的方法观察标本中的脏层腹膜侵犯、脏层腹膜弹力层侵犯和血管侵犯情况，并观察与淋巴结转移、血管侵犯、神经侵犯及肿瘤出芽之间的关系。 结果 弹力纤维染色脏层腹膜弹力层肿瘤侵犯的检出率高于HE染色的检出率，差异有统计学意义（P < 0.05）;脏层腹膜弹力层侵犯阳性患者其淋巴结转移、静脉侵犯及肿瘤出芽发生率高于脏层腹膜弹力层侵犯阴性的患者，差异有统计学意义（P < 0.05）;脏层腹膜弹力层侵犯阳性患者其神经侵犯发生率高于脏层腹膜弹力层不存在的患者，差异有统计学意义（P < 0.05）;弹力纤维染色血管侵犯检出率高于HE染色，差异有统计学意义（P < 0.05），其特异性为100.0%，敏感性为65.8%。 结论 弹力纤维染色能够明显提高结直肠癌的脏层腹膜弹力层侵犯和血管侵犯检出率，脏层腹膜弹力层侵犯阳性的患者提示肿瘤预后不良，脏层腹膜弹力层侵犯可能作为结直肠癌分期的临床病理指标之一。

[关键词] 癌;结直肠;脏层腹膜;弹力层侵犯;血管侵犯

[中图分类号] R365          [文献标识码] A          [文章编号] 1673-7210（2020）07（a）-0024-04

[Abstract] Objective To explore the application value and clinical significance of elastica staining in identifying visceral peritoneal elastic lamina invasion and vascular invasion of colorectal cancer. Methods From January 2013 to December 2016， 75 colorectal cancer histological specimens were selected from Qingdao Municipal Hospital， the peritoneal invasion of the visceral layer， the peritoneal invasion of the visceral layer and the vascular invasion in the specimens were observed by conventional HE staining and lichen red elastic fiber staining. The relationship among lymph node metastasis， vascular invasion， nerve invasion and tumor budding were observed. Correlations between visceral peritoneal elastic lamina invasion and lymph metastasis， vascular invasion， perineural invasion， tumor budding were also investigated. Results Elastic fiber staining results showed the positive rate of visceral peritoneal elastic lamina invasion was higher than that of HE staining， and the difference was statistically significant （P < 0.05）; the incidence of lymph metastasis， vascular invasion and tumor budding in visceral peritoneal elastic lamina invasion positive cases were higher than those in peritoneal elastic lamina invasion negative cases， the differences were statistically significant （P < 0.05）; the incidence of nerve invasion in patients with positive visceral peritoneal elastic layer invasion was higher than that in patients without visceral peritoneal elastic layer invasion， and the difference was statistically significant （P < 0.05）; elastic fiber staining revealed that the detection rate of vascular invasion was higher than HE staining， and the difference was statistically significant （P < 0.05）， and with 100.00% specificity and the 65.8% sensitivity. Conclusion Elastic fiber staining can significantly improve the detection rate of visceral peritoneal elastic layer invasion and vascular invasion. Patients with positive visceral peritoneal elastic layer invasion suggest poor tumor prognosis， and visceral peritoneal elastic layer invasion may be one of the clinicopathological indicators for colorectal cancer staging.

[Key words] Cancer; Colorectum; Visceral peritoneal; Elastic lamina invasion; Vascular invasion

结直肠癌（colorectal cancer，CRC）是人类高发恶性肿瘤，相关数据显示我国结直肠癌发病率在全部恶性肿瘤中居第5位，死亡/发病比为50.8%[1]。脏层腹膜侵犯（visceral peritoneal invasion，VPI）是结直肠癌术后病理分期（pTNM）及临床个体化治疗的重要指标。在实际临床病理工作中，VPI的判定主要依据HE染色的镜下观察，由于肿瘤组织破坏腹膜结构，周围胶原纤维增生及炎性反应易导致脏层腹膜侵犯的低诊断，因此能否找到客观性判读指标是结直肠癌病理分期中需要解决的重要问题。血管侵犯（vascular invasion，VI）是结直肠癌Ⅰ类预后因子[2-3]，是评估远处转移、肿瘤预后和疗效预测的重要指标[4-6]，HE染色镜下观察和免疫组化染色均可造成假阴性结果。本研究通过弹力纤维染色检测结直肠癌组织中脏层腹膜弹力层侵犯（visceral peritoneal elastic lamina invasion，VPELI）和VI的发生率，并观察与淋巴结转移、VI、神经侵犯、肿瘤出芽之间的关系，考察弹力纤维染色以及VPELI在结直肠癌临床病理分期中的应用价值及意义。……