| ObjectiveThe aim of the study is 0to Study the property and distribution regulate of transitional mucosa(TM) adjacent to rectal carcinoma and the clinical significance of Survivin gene increasing expression. (2)to investigate the expression of KAI1/CD82, integrin α5 gene and the correlation with micrometastasis of human rectal carcinoma, and discuss their clinical meanings. (3) to evaluate the effect of biofeedback therapy in postoperative anorectal malfunction of patients with rectal cancer.Materials and Methods(1)We used the mucinhistochemical methods to observe the range of TM adjacent to rectal carcinoma and immunohistochemical methods to observe Survivin gene product on TM, using normal mucosa, atypical dysplasia and cancer tissue as control. (2)KAI1 mRNA ,integrin a5 mRNA expression in primary carcinomas was examined by in situ hybridization histochemistry (ISHH) , 20 normal rectal mucosa tissue samples served as controls; CA20 mRNA expression in blood and mesorectal lymph node was examined by fluorescence quantitative reverse transcription polymerase chain reaction ( FQ - PCR ). (3) Defecograph, anorectal manometry, electromyogram and anal sphincter electrophysiological study were performed on 31 patients of post surgery - Biofeedback therapy was carried outselectively to strengthen the peri - anal muscle tone, improve the rectal sensitivity and shorten the reflex time and so on .Results1. The range of TM in mucinous carcinoma was significantly larger than those in papillate adenocarcinoma and tubular adnocarcinoma( P <0.01) ; The range of TM in the carcinoma at Dukes C stage was significantly larger than those at Dukes A and B stages(P <0.01 ,P <0.05).2. The positive expression level of Survivin gene product was lowest in normal rectal mucosa,, gradually increase in TMNdysplasia and carcinoma tissue (P<0.05).3. The CA20mRNA was more expressed in the mesentery lymph node a-bove the level of tumor' s distal margin than that in the below ( P <0.05) .4. KAIlmRNA were more expressed in primary carcinomas than in normal mucosa with significant statistical meaning (P<0.05).5. The expressing level of KAI1 mRNA in rectal cancer with lymph node and blood micrometastasis is lower than those without the micrometastasis ( X = 8.92, P<0.05;x2 =9.94,P<0.01) , The expressing level of KAI1 mRNA is negative correlation with CA20 in the lymph node ( r = -0. 377, P =0.01) with significant statistical meaning . there are no relationship with the age N sex ^ the differentiation of tumor and the tumor' s invasion .6. The expressing level of integrin a5 is negative correlation with CA20 in the blood , and whether the lymph node micrometastasis occurred(r= -0.354, P =0.003 <0.01) with significant statistical meaning . and no relationship with the age?sex?the differentiation of tumor and the tumor' s invasion.7. There were statistically significant correlations between KAI1 mRNA and Integrin a5 mRNA expression . ( P < 0 . 05 ).8. The clinical scores of the patients with low and intermediate segment of rectal cancer improved from 3 . 7 ± 1 .0to5 . 7 ifc 0 .5, whereas those with high segment improved from 2 . 3 dr 1 . 0 to 4 .6 dr 0 .5 after biofeedback therapy. The parameters of peri - anal muscle tone,rectal function and the obility ofanorectal comprehensive control showed significant improvement compared to those without biofeedback therapy or those with home pelvic exercise only.Conclusions1. The up - regulation expression of Survivin gene in TM ? atypical dysplasia and rectal carcinoma suggested that Survivin may play a important role in the pathway of carcinogenesis and Survivin may be identified as a potential gene therapeutic target in rectal carcinoma; The range of TM was closely related to the pathological type and the advancement of rectal carcinoma. The results indicated that the indications for sphincter preserving operations should be strictly applied in rectal mucinous adnoma or rectal carcinoma in Dukes C stage.2. We used the fluorescence quantitative reverse transcription polymerase chain reaction (FQ - PCR) to examine the expression of CA20mRNA in blood and lymph node , use in situ hybridization histochemistry (ISHH) to examine the expression of KAIl mRNA,integrin a5 mRNA in the rectal mesentery, and discuss their clinical meanings. We got the conclusions as follows:(1) The expressing level of CA20mRNA in the mesentery lymph node a-bove the level of tumors distal margin is higher than that in the below with statistical meaning, which prove in the molecular level that the micrometastasis'direction is mainly upwards.(2) KAIl mRNA was more expressed in primary carcinomas than in normal mucosa, the up - regulation expression of KAIl, intregrin α5 gene maybe suggest that is related to the occurrence of rctal carcinoma.(3) The low expression of KAI1, intregrin α5 gene has close relation with the micrometastasis and the malignant progress of rectal carcinoma, which suggest that the KAI1, intregrin α5 gene can be used as a factor to predict the lymph node and blood metastasis of the rectal carcinoma. Its low or no expression predicts that the rectal carcinoma has more severe invasion and metastasis. But it has no relationship with the age , sex , the differentiation of tumor and thetumor' s invasion.(4) There were statistically significant correlations between KAIl mRNA...
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