应用傅里叶变换红外光谱(FTIR)联合主成分分析法(PCA), 分析直肠癌转移淋巴结的谱学特征, 并对直肠癌转移淋巴结和非转移淋巴结进行线性判别分析。 80例直肠癌转移淋巴结和80例未转移淋巴结进行FTIR光谱分析, 计算峰强并进行主成分分析, 得出在波数4 000～1 700 cm-1范围主成分1(Principal components 1, PC1)是3 260 cm-1, PC2为1 740 cm-1。 波数1 700～1 000 cm-1范围, PC1为1 640 cm-1, PC2为1 080 cm-1, 将良、 恶性淋巴结光谱3 260, 1 740, 1 640, 1 080 cm-1相对峰强比(I/I1 460)和波数1 080和1 300 cm-1进行t检验, 良、 恶性结果差异有统计学意义(p<005), 表明癌转移淋巴结中蛋白含量、 蛋白的形成、 氨基酸增多； 脂肪含量明显减少与癌组织中无氧酵解脂肪含量减少有关。 将相对峰强比(I1 080/I1 460, I1 640/I1 460, I3 260/I1 460, I1 740/I1 460, n=160)进行PCA聚类分析, 结果显示可以将良恶性淋巴结鉴别, 良性淋巴结聚类在第一和四象限, 恶性淋巴结聚类在二和三象限。 将相对峰强比、 1 080和1 300 cm-1进行线性判别分析(LDA), 将25例淋巴结作为验证集进行分析, 得出PCA/LDA模型的敏感度是875%, 特异度是885%。 结果表明傅里叶变换红外光谱分析技术可成为术中原位、 在体和快速诊断直肠癌淋巴结转移的一种简便方法。

This study aimed to investigate the influence of laparoscopic total mesorectal excision combined with sphincter-preserving surgery on the postoperative defecation function, urinary function and sexual function in low or ultralow rectal cancer. A retrospective study was undertaken on 107 patients (65 laparoscopic resection and 42 laparoctomic resection) with rectal cancer undergoing laparoscopic or open laparoscopic total mesorectal excision combined with sphincter-preserving surgery from April 2009 to April 2013. The quality of life outcomes of all patients, including defection, urinary and sexual function, were assessed at 6, 12 and 24 months after operation. Gastrointestinal quality of life index (GQOLI) was used to evaluate the fecal incontinence and bowel dysfunction. Urinary and sexual functions were studied by means of questionnaires on the basis of the international prostatic symptom score (IPSS) and international index of erectile function (IIEF), respectively. In laparoscopic surgery group, there were two cases of anastomotic leakage, three cases of anastomotic stricture, seven cases of local recurrence, ten cases of hepatic metastasis and five cases of lung metastasis. The satisfaction rates of patients about their defecation function reached 60.3% (35/58, 84.5% (49/58) and 91.3% (53/58) at 6, 12, and 24 months follow-up, respectively. The assessment after one year showed that the overall incidence of urinary dysfunction was 10.7% (7/65); Among male patients, 18.4% (7/36) suffered from erectile dysfunction and 27.8% (10/36) suffered from ejaculatory dysfunction; 65.5% (19/29) female patients investigated were satisfied with their postoperative sexual life. In open surgery group, there were two cases of anastomotic leakage, two cases of anastomotic stricture, nine cases of local recurrence, ten cases of hepatic metastasis and seven cases of lung metastasis. The satisfaction rates of patients about their defecation function were 56.4% (22/39), 82.1% (32/39) and 94.8% (37/39) at 6, 12, and 24 months follow-up, respectively. The assessment after one year showed that the overall incidence of urinary dysfunction was 11.9% (5/42); 25% (4/16) male patients suffered from erectile dysfunction and 31.3% (5/16) suffered from ejaculatory dysfunction; 69.2% (19/26) female patients investigated were satisfied of their postoperative sexual life. There was no statistic difference in the two groups. Laparoscopic total mesorectal excision combined with sphincter-preserving surgery in low or ultralow rectal carcinoma is safe and practicable. It can be helpful for enhancing the probability of anus reservation, and obtains satisfactory defecation, sexual and urinary functions.