| Objective: To study the distribution of lymph in rectum and anus and explore the clinical value.Methods: A total of fifteen patients with rectal cencer underwent abdominal perineal resection(APR)in The First Affiliated Hospital of Guangxi Medical University from December 2015 to April 2017 were enrolled.After the approval of hospital ethics management and consent of patients,they were randomly divided into three groups(n = 5).The local tissue specimens(including external anal sphincter)in A group were examined by immunohistochemical method;the injection of indocyanine green to detect lymph tracer were used in the B group;low molecular nano carbon injection to detect lymph tracer before operation were used in C group.The condition and clinical significance of anal lymphatic were systematically shown via the analysis of results in each group.Results: There were lymphatic vessels but without lymph node tissue in the sample of external anal sphincter after APR in A group.The fluorescence from indocyanine green were in backflow upward,downward and sideways along with lymph via the scanning of perianal and groin skin during and after operation,which samples were injected with indocyanine green at mucosa of anal canal in B group.The strong fluorescent point of lymph gland in B group was observed at inguinal and mesenteric arteries and not found in external anal sphincter and perianal adipose tissue.There were black-staining lymph gland at mesenteric lymphatic vessels and main vessels,but not observed at external anal sphincter and space after injection with nano carbon at mucosa of anal canal in C group.Conclusions: There are no lymph gland at external anal sphincter and perianal adipose tissue resulting from the no probability of lymph node metastasis.These patients with ultra-low rectal cancer who would be excluded with direct invasion of external anal sphincter,meet with surgical indications to the accomplishment of inter sphincter resection(ISR). |
PDF Full Text Request