Intra-operative peritoneal lavage for colorectal cancer

Free cancer cells can be detected in peritoneal fluid at the time of colorectal surgery.Peritoneal lavage in colorectal surgery for cancer is not used in routine,and the prognostic significance of intraperitoneal free cancer cells(IPCC)remains unclear.Data concerning the technique of peritoneal lavage to detect IPCC and its timing regarding colorectal resection are scarce.However,positive IPCC might be the first step of peritoneal spread in colorectal cancers,which could lead to early specific treatments.Because of the important heterogeneity of IPCC determination in reported studies,no treatment have been proposed to patients why positive IPCC.Herein,we provide an overview of IPCC detection and its impact on recurrence and survival,and we suggest further multi-institutional studies to evaluate new treatment strategies.     

Evaluation of intraperitoneal lavage cytology before colorectal cancer resection

Purpose  The aim of this study was to assess the usefulness of intraperitoneal lavage cytology (lavage Cy) status before the resection of colorectal cancer as a predictive factor of peritoneal recurrence. Materials and methods  The lavage Cy-positive [lavage Cy (+)] rate, peritoneal recurrence rate, and 5-year survival rate were examined in 298 cases of colorectal cancer in relation to various clinicopathological factors. Results  The overall lavage Cy (+) rate was 6.0%. The lavage Cy (+) rate within the group with peritoneal and hepatic metastases was significantly higher than that in the group without metastases (46.7% vs. 3.9% and 26.9% vs. 4.0%, respectively). The lavage Cy (+) rate was not significantly associated with any of the clinicopathological factors examined. The peritoneal recurrence rate was higher in the lavage Cy (+) group than in the lavage Cy-negative [lavage Cy (−)] group, although the difference was not statistically significant. There was no significant difference in survival, regardless of the lavage Cy status, among the 263 patients who underwent curative resection. Conclusion  The lavage Cy status before resection was not a useful predictive factor of peritoneal recurrence in cases of colorectal cancer.     

Treatment of primary colon cancer with peritoneal carcinomatosis

PURPOSE: The initial dissemination of colon cancer occurs through three routes: the lymphatics, the portal blood, and the peritoneal surfaces. Although lymphatic and hematogenous metastases indicate an aggressive disease process, it is possible that dissemination to peritoneal surfaces may be only superficial contamination of the parietal and visceral peritoneum that may be treatable for cure. Unfortunately, surgery may have an adverse impact on peritoneal surface dissemination. Surgical interventions may convert a superficial process into an invasive condition with a greatly reduced prognosis. This study was conducted to test this hypothesis by the use of data prospectively recorded from patients treated for peritoneal carcinomatosis concomitant with resection of the primary colon cancer or treated for carcinomatosis after disease recurrence prompted referral. METHODS: Our first group of patients had definitive treatment of carcinomatosis simultaneous with resection of the primary colon cancer. They had cytoreductive surgery including peritonectomy procedures followed by heated intraoperative intraperitoneal chemotherapy with mitomycin C plus early postoperative intraperitoneal 5-fluorouracil. The comparison group was treated with a colon resection at an outside hospital and then later referred to us with progressive disease for treatment. The major difference between the groups is the timing of the definitive treatment of carcinomatosis. These patients were also studied by use of the completeness of the cytoreduction score and the peritoneal cancer index as prognostic indicators. Survival was the end point for all the analysis. RESULTS: Of 104 patients with peritoneal carcinomatosis from colon or rectal adenocarcinoma, five patients (4.8 percent) had definitive treatment of the peritoneal surface spread of the cancer concomitant with resection of the primary lesion. Median survival for these patients has not been reached and their five-year survival rate is 100 percent. The remainder of the patients (n=99) were referred for local and regional recurrence after their primary cancer had been removed and there was progression of carcinomatosis. Forty-four patients (42.3 percent) had a complete cytoreduction resulting in a 24-month median survival and a 30 percent five-year survival (P<0.0001). The other 55 patients (52.9 percent) had an incomplete cytoreduction resulting in a 12-month median survival and a 0 percent five-year survival (P<0.0001). Patients with a peritoneal cancer index of 10 or less had a 48-month median survival and a 50 percent five-year survival rate. Patients with a peritoneal cancer index between 11 and 20 had a 24-month median survival and a 20 percent five-year survival rate (P<0.0001). Patients with a peritoneal cancer index of more than 20 had a 12-month median survival and a 0 percent five-year survival (P<0.0001). CONCLUSIONS: In patients with peritoneal seeding occurring at the time of resection of the primary malignancy, peritonectomy procedures and perioperative intraperitoneal chemotherapy should be performed concomitantly. By use of a quantitative scoring system, the mass of cancer present in the abdomen and pelvis at the time of treatment of carcinomatosis correlated directly with survival. Aggressive treatment of patients with peritoneal carcinomatosis requires consideration in the management of colorectal cancer.     

胃癌患者术前腹腔冲洗液游离DNA中TIMP-3基因甲基化与腹腔微转移的相关性

目的:探讨胃癌患者术前腹腔冲洗液中组织金属蛋白酶抑制因子-3(tissue inhibitor ofmetalloproteinase 3,TIMP-3)基因启动子CpG岛异常甲基化与腹腔微转移的相关性.方法:应用甲基化特异性实时荧光聚合酶链反应技术检测92例胃癌患者术前腹腔冲洗液中TIMP-3基因启动子CpG岛甲基化状态,分析TIMP-3基因异常甲基化与患者临床病理参数及预后之间的关系.结果:在92例胃癌患者术前腹腔冲洗液标本中,有49(53.26%)例检测到了TIMP-3基因甲基化,且TIMP-3基因甲基化与肿瘤大小(P=0.013)、静脉侵犯(P=0.030)和远处转移(P=0.013)间均存在相关性,与生长方式、分化程度、淋巴管侵犯、淋巴结转移、浸润深度和临床分期间存在显著相关性(P=0.000),而与性别、年龄、Helicobacter pylori感染状况以及肿瘤部位等不存在相关性(P分别为0.833、0.236、0.300、0.236).生存分析发现TIMP-3基因非甲基化患者具有独立的生存优势(P=0.000).结论:胃癌患者术前腹腔冲洗液游离DNA中TIMP-3基因异常甲基化可反映腹腔微转移发生,并提示预后不良.     

腹腔镜探查联合灌洗活检在进展期胃癌术前分期中的价值

目的:探讨腹腔镜探查联合腹腔灌洗活检对进展期胃癌术前分期及术式选择的临床意义.方法:回顾分析北京大学肿瘤医院43例胃癌患者腹腔镜探查经过,结果及治疗方案.结果:43例患者腹腔镜探查均获成功,探查操作时间为30-45min(平均32min),术中出血少.探查发现:腹膜转移者14例,肿瘤直接侵犯周围脏器1例.肿瘤突破浆膜者27例,未突破浆膜者16例,其中有4例镜下触诊不明显.所有患者行腹腔灌洗,其中阳性者16例,阳性率为37.2%.结论:胃癌患者术前预行腹腔镜探查和灌洗对于术前分期和选择合适的术式具有重要的指导意义.     

Complete peritonectomy and intraperitoneal chemotherapy for recurrent rectal cancer with peritoneal metastasis

A 68-year-old man underwent laparoscopic low anterior resection for rectal carcinoma in December 2006. Nearly 19 mo after the operation, he developed recurrent rectal cancer with peritoneal metastasis. In September 2008, he subsequently underwent a laparotomy with a peritonectomy, omentectomy, splenectomy, and a Hartmann procedure. Hyperthermic intraperitoneal oxaliplatin 750 mg was administered. The patient was discharged with no postoperative complications and has been well with postoperative FOLFOX chemotherapy.     

Clinical significance of telomerase activity in peritoneal lavage fluid from patients with gastric cancer and its relationship with cellular proliferation

AIM: To evaluate the efficacy of telomerase activity assay and peritoneal lavage cytology (PLC) examination in peritoneal lavage fluid for the prediction of peritoneal metastasis in gastric cancer patients, and to explore the relationship between telomerase activity and proliferating cell nuclear antigen expression. METHODS: Telomeric repeated amplification protocol (TRAP)-enzyme-linked immunosorbent assay (ELISA) was performed to measure the telomerase activity in 60 patients with gastric cancer and 50 with peptic ulcer. PLC analysis of the 60 patients with gastric cancer was used for comparison. The proliferating cell nuclear antigen (PCNA) in gastric carcinoma was immunohistochemically examined. RESULTS: The telomerase activity and PLC positive rate in peritoneal lavage fluid from patients with gastric cancer was 41.7/ (25/60), and 25.0/ (15/60), respectively. The positive rate of telomerase activity was significantly higher than that of PLC in the group of pT4 (15/16 vs 9/16, P < 0.05), P1-3 (13/13 vs 9/13, P < 0.05) and diffuse type (22/42 vs 13/42, P < 0.05). The patients with positive telomerase activity, peritoneal metastasis, and serosal invasion had signifi cantly higher levels of average PCNA proliferation index (PI), (55.00 ± 6.59 vs 27.43 ± 7.72, 57.26 ± 10.18 vs 29.15 ± 8.31, and 49.82 ± 6.74 vs 24.65 ± 7.33, respectively, P < 0.05).CONCLUSION: The TRAP assay for telomerase activity is a useful adjunct for cytologic method in the diagnosis of peritoneal micrometastasis and well related to higher proliferating activity of gastric cancer. The results of this study also suggest a promising future therapeutic strategy for treating peritoneal dissemination based on telomerase inhibition.     

Gastrointestinal perforation in metastatic colorectal cancer patients with peritoneal metastases receiving bevacizumab

AIM:To investigate the safety and efficacy of adding bevacizumab to first-line chemotherapy in metastatic colorectal cancer patients with peritoneal disease.METHODS:We compared rates of gastrointestinal perforation in patients with metastatic colorectal cancer and peritoneal disease receiving first-line chemotherapy with and without bevacizumab in three distinct cohorts:(1) the AGITG MAX trial(Phase Ⅲ randomised clinical trial comparing capecitabine vs capecitabine and bevacizumab vs capecitabine,bevacizumab and mitomycin C);(2) the prospective Treatment of Recurrent and Advanced Colorectal Cancer(TRACC) registry(any first-line regimen ± bevacizumab);and(3) two cancer centres in New South Wales,Australia [Macarthur Cancer Therapy Centre and Liverpool Cancer Therapy Centre(NSWCC) from January 2005 to Decenber 2012,(any first-line regimen ± bevacizumab).For the AGITG MAX trial capecitabine was compared to the other two arms(capecitabine/bevacizumab and capecitabine/bevacizumab/mitomycin C).In the AGITG MAX trial and the TRACC registry rates of gastrointestinal perforation were also collected in patients who did not have peritoneal metastases.Secondary endpoints included progression-free survival,chemotherapy duration,and overall survival.Time-toevent outcomes were estimated using the Kaplan-Meier method and compared using the log-rank test.RESULTS:Eighty-four MAX,179 TRACC and 69 NSWCC patients had peritoneal disease.There were no gastrointestinal perforations recorded in either the MAX subgroup or the NSWCC cohorts.Of the patients without peritoneal disease in the MAX trial,4/300(1.3%) in the bevacizumab arms had gastrointestinal perforations compared to 1/123(0.8%) in the capecitabine alone arm.In the TRACC registry 3/126(2.4%) patients who had received bevacizumab had a gastrointestinal perforation compared to 1/53(1.9%) in the chemotherapy alone arm.In a further analysis of patients without peritoneal metastases in the TRACC registry,the rate of gastrointestinal perforations was 9/369(2.4%) in the chemotherapy/bevacizumab group and 5/177(2.8%) in the chemotherapy alone group.The addition of bevacizumab to chemotherapy was associated with improved progression-free survival in all three cohorts:MAX 6.9 m vs 4.9 m,HR = 0.64(95%CI:0.42-1.02);P = 0.063;TRACC 9.1 m vs 5.5 m,HR = 0.61(95%CI:0.37-0.86);P = 0.009;NSWCC 8.7 m vs 6.8 m,HR = 0.75(95%CI:0.43-1.32);P = 0.32.Chemotherapy duration was similar across the groups.CONCLUSION:Patients with peritoneal disease do not appear to have an increased risk of gastrointestinal perforations when receiving first-line therapy with bevacizumab compared to systemic therapy alone.     

Limitations with light microscopy in the detection of colorectal cancer cells

PURPOSE: The failure of light microscopy to predict individual patient survival accurately in pStage I and II colorectal carcinoma can hinder planning postoperative therapy and follow-up. This study was designed and conducted in two parts to assess the influence of relative sensitivity of the light microscope on the pathologist's ability to detect malignant cells in lymph nodes. METHODS: The first part of the study examined the issue of sampling error as a fraction of the number of lymph node sections examined by asking the question, “Does increasing the number of sections (sampling) taken from the block increase tumor cell detection in a lymph node?” Three levels of five sections 4 to 5 µm thick separated by 15 to 20 µm were obtained from each of 494 blocks from 173 cases of pStage I and II colorectal carcinoma. A total of 1,721 lymph nodes were examined. Sections from each level were stained with hematoxylin and eosin and for the expression of cytokeratin. The second part of the study examined the relative sensitivity of the light microscope to detect tumor cells in a lymph node. To simulate lymph nodes, cell blocks were made that contained 10⁶ or 10⁷ mononuclear cells admixed with increasing numbers of SW480 tumor cells (0, 50, 10², 5×10², 10³, and 5×10³). Three pathologists independently examined sections from ten control and ten experimental blocks. RESULTS: Results from the first part of the study demonstrated cytokeratin-positive cells in 278 lymph nodes from 102 of 172 (59 percent) cases. These cells were identified in the first level in 177 (64 percent) as compared with the second or third level or both in 101 (36 percent) of the lymph nodes. Results from the second part of the study demonstrated an overall sensitivity of light microscopic examination of hematoxylin and eosin-stained sections to be approximately 23 percent, representing tumor cells correctly detected in 7 sections of the 30 sections containing tumor cells. The overall specificity was 87 percent or 26 sections correctly classified as lacking tumor cells of a possible 30. Immunohistochemical staining for cytokeratin expression improved sensitivity of the light microscope to detect tumor cells to 18 of 30 (60 percent) and the specificity to 30 of 30 (100 percent). CONCLUSION: This study demonstrates several sources of variability that can induce errors in pathologic staging. These include 1) inadequate section,i.e., sampling, of lymph nodes, 2) use of only hematoxylin and eosin-stained sections, 3) samples with tumor cells below the level of detection sensitivity of the light microscope, and 4) observer variability.     

Peritoneal lavage cytology and carcinoembryonic antigen determination in predicting peritoneal metastasis and prognosis of gastric cancer

AIM: To evaluate the role of peritoneal lavage cytology (PLC) and carcinoembryonic antigen (CEA) determination of peritoneal washes (pCEA) in predicting the peritoneal metastasis and prognosis after curative resection of gastric cancer. METHODS: PLC and radioimmunoassay of CEA were performed in peritoneal washes from 64 patients with gastric cancer and 8 patients with benign diseases. RESULTS: The positive rate of pCEA (40.6%) was significantly higher than that of PLC (23.4%) (P<0.05). The positive rates of PLC and pCEA correlated with the depth of tumor invasion and lymph node metastasis (P<0.05). pCEA was found to have a higher sensitivity and a lower false-positive rate in predicting peritoneal metastasis after curative resection of gastric cancer as compared to PLC. The 1-, 3-, and 5-year survival rates of patients with positive cytologic findings or positive pCEA results were significantly lower than those of patients with negative cytologic findings or negative pCEA results (P<0.05). Multivariate analysis indicated that pCEA was an independent prognostic factor for the survival of patients with gastric cancer. CONCLUSION: Intraoperative pCEA is a more sensitive and reliable predictor of peritoneal metastasis as well as prognosis in patients with gastric cancer as compared to PLC method.     

The effect of peritoneal lavage with tetracycline solution on postoperative infection

A prospective randomized trial was performed to determine the value of tetracycline lavage in addition to systemic antibiotic prophylaxis in 159 patients undergoing elective and emergency intestinal operations. Tetracycline lavage was associated with a significant overall reduction in postoperative infection rates in 25 of 74 patients (34 percent) receiving saline lavage compared with 15 of 85 patients (18 percent) having tetracycline lavage (P<0.05). Tetracycline lavage was associated with a significant reduction in the counts of aerobic and anaerobic bacteria in the peritoneal fluid at the end of the operation (P<0.05 andP<0.01, respectively) and with a significant reduction of aerobes 24 hours postoperatively (P<0.02). Tetracycline lavage would appear to confer clinical benefit in preventing postoperative infection. Some of the data in this study were presented at the meeting of the Association of Surgeons of Great Britian and Ireland, Birmingham, United Kingdom, March 1985.     

NOSES结直肠癌根治术后腹腔冲洗液肿瘤细胞学检测及细菌培养结果分析

目的分析经自然腔道取标本手术（NOSES）完全腹腔镜下结直肠癌根治术后患者腹腔冲洗液的肿瘤细胞学检测、细菌培养的结果及其临床意义。 方法留取2016年1月至2018年4月湘雅医院普外结直肠肛门外科30例行NOSES完全腹腔镜下结直肠癌根治术患者术后腹腔冲洗液,分装两份,分别送病理科查找肿瘤细胞和检验科行细菌培养,收集肿瘤细胞学检测及细菌培养结果,并与国内外文献报道的开腹和常规腹腔镜结直肠癌根治术腹腔冲洗液的肿瘤细胞检测及细菌培养结果比较分析。 结果30例NOSES完全腹腔镜下结直肠癌根治术患者的腹腔冲洗液肿瘤细胞阳性的患者0例,阳性率0%（0/30）;细菌培养阳性的患者有10例,阳性率33.3%（10/30）;至目前为止30例NOSES患者术后均未出现盆/腹腔感染及盆/腹腔肿瘤的复发转移。这一结果与国内外文献报道的开腹及常规腹腔镜结直肠癌根治术后腹腔冲洗液的肿瘤细胞学检查（0%~45.5%）和细菌培养结果（20%~32.5%）相近。 结论与开腹和常规腹腔镜结直肠癌根治术相比,NOSES结直肠癌根治术未增加患者术后盆腹腔感染及未促进肿瘤细胞种植转移,符合恶性肿瘤根治术的无菌无瘤原则,值得临床推广应用。     

肿瘤细胞减灭术加腹腔热灌注化疗治疗结直肠癌腹膜转移癌的临床研究

目的：探讨肿瘤细胞减灭术（CRS）加腹腔热灌注化疗（HIPEC）治疗结直肠癌腹膜转移癌（ CRC PC）的疗效及安全性。方法选取结直肠癌腹膜转移癌（ CRC PC）患者67例,随机分为治疗组（ CRS＋HIPEC）38例,对照组（CRS＋静脉辅助化疗）29例,比较两组的生存期、生存率、术后并发症及化疗毒副作用。结果治疗组中位生存期23.0个月,显著长于对照组的11.0个月（ P＜0.01）,治疗组1、2、3年生存率分别为70.9％、45.7％、8.2％,分别优于对照组的68.8％、21.2％、0％。术后并发症发生率两组相似（ P＞0.05）。化疗毒副作用：对照组恶心呕吐、白细胞减少、血小板减少发生率较治疗组高（P＜0.01）,而治疗组腹胀、腹泻发生率较对照组高（ P＜0.01或P＜0.05）;两组其他毒副作用相似（ P＞0.05）。结论 CRS＋HIPEC治疗CRC PC能明显延长患者生存期,并发症和化疗毒副作用并没有明显增加。     

Current role of hyperthermic intraperitoneal chemotherapy in the treatment of peritoneal carcinomatosis from colorectal cancer

Peritoneal carcinomatosis is one of the most common routes of dissemination of colorectal cancer (CRC). It is encountered in 7% of patients at primary surgery, while it develops in about 4% to 19% of patients after curative surgery and in up to 44% of patients with recurrent CRC. Peritoneal involvement from colorectal malignancies has been considered traditionally as a manifestation of terminal disease, due to limited response to conventional surgical and chemotherapeutic treatments. In the past few years t...     

Does laparoscopicvs. Conventional surgery increase exfoliated cancer cells in the peritoneal cavity during resection of colorectal cancer?

PURPOSE: Traumatic manipulation of cancer specimens during laparoscopic colectomy may increase exfoliation of malignant cells into the peritoneal cavity, causing an early occurrence of peritoneal carcinomatosis or port-sites recurrence. Because of this concern, the routine use of intraperitoneal chemotherapy after laparoscopic colectomy for cancer was suggested recently. We assessed if laparoscopicvs. conventional surgery increases exfoliated malignant cells in the peritoneal cavity during resection of colorectal cancer. METHODS: In a prospective, randomized fashion, 38 colorectal cancer patients undergoing an elective, curative operation were assigned to either a conventional or laparoscopic procedure between June 1996 and May 1997. In either group (n=19), after the abdominal cavity was entered, saline was instilled into the peritoneal cavity, and the fluid was collected (Specimen 1). During surgery, all irrigating fluids were collected (Specimen 2). Both specimens were assessed for malignancy using four techniques: filtration process (ThinPrep®), smear, cell block, and immunochemistry using Ber-EP4. The change in the amount of tumor cells in both specimens was compared between surgical groups. A pilot study was performed to validate the proposed cytologic method. RESULTS: In the pilot study of 20 consecutive patients with colorectal cancer, postresectional peritoneal cytology was positive in six patients, including two Stage II (T3,N0,M0) patients. The pilot study also validated that our semiquantitative scoring system can be reliably used to assess the amount of free peritoneal cancer cells. In the main study, 16 right colectomies, 3 extended right colectomies, 17 proctosigmoidectomies, and 1 left colectomy were performed. The T and N stages were T1 (n=13), T2 (n=5), T3 (n=8), T4 (n=11); N0 (n=22), N1 (n=8), N2 (n=7). Malignant cells were not detected in any Specimens 1 or, more importantly, in Specimens 2 in either surgical group. CONCLUSION: When performed according to strict oncologic surgical principles, laparoscopic techniques in curative colorectal cancer surgery did not have an increased risk of intraperitoneal cancer cell spillage, compared with conventional techniques. We hope that these results can decrease some of the concerns about tumors cell spillage and seeding during laparoscopy.Supported by a grant from the Minimally Invasive Surgery Center, The Cleveland Clinic Foundation, Cleveland, Ohio.Read at the meeting of The American Society of Colon and Rectal Surgeons, Philadelphia, Pennsylvania, June 22 to 26, 1997.     

腹带加压预防腹膜透析患者术后并发症的临床观察

目的探讨腹带加压对腹膜透析患者伤口拆线时间、伤口渗液、出血及隧道口炎、导管移位发生率的影响,为防治腹膜透析并发症提供新的治疗方法。方法根据腹膜透析术后是否采用腹部伤口腹带加压,将患者分为腹膜透析插管后3个月内腹带加压组(A组)和未使用腹带加压对照组(B组),观察两组患者的伤口拆线时间、伤口渗液、出血及透析管相关隧道口炎、导管移位的发生率。结果 (1)A组平均拆线时间为(11.2±0.8)d,B组平均拆线时间为(13.4±0.7)d,两组比较有统计学差异(P0.01)。(2)术后A组有1例患者发生伤口渗血,而B组有8例患者出现伤口渗血,明显高于A组(P0.05);术后A组有1例隧道口炎发生,而B组有7例患者在术后3个月发生隧道口炎,与A组比较有统计学差异(P0.05),两组患者予以规范抗感染治疗后均治愈。(3)A组有1例患者在术后第2天出现管周渗液,发生率为2.94%;B组有1例患者在术后第1天出现管周渗液,发生率为3.03%,两组比较无统计学差异(P0.05)。(4)A组有1例患者出现导管移位,发生率为2.94%;B组有1例患者出现导管移位,发生率为3.03%,两组比较无统计学差异(P0.05)。结论腹带加压可缩短手术后拆线时间,可减少术后腹部伤口渗血及隧道口炎的发生率,极大地减少了术后并发症的发生,可促进患者早日康复,能有效延长腹膜透析患者的透析时间和治疗效果,减少腹透早期退出率,提高患者生活质量。     

Differently charged polypeptides in the prevention of post-surgical peritoneal adhesions

Objective. Peritoneal adhesions develop after almost all surgical interventions in the abdomen. We have developed an efficient treatment against post-surgical adhesions consisting of a combination of positively charged poly-L-lysine and negatively charged poly-L-glutamate. The aim of the present study was to further develop the concept of applying oppositely charged polypeptides in the prevention of adhesion formation, by evaluating different doses of the peptides, alterations in the way of administration, and also testing alternative components. Material and methods. Eighty-five NMRI mice were divided into six groups. A standardized peritoneal injury model was used. The groups received physiologic sodium chlorine, poly-L-lysine+poly-L-glutamate, low molecular weight poly-L-lysine+poly-L-glutamate, locally administered poly-L-lysine+poly-L-glutamate, in vitro mixed poly-L-lysine+poly-L-glutamate and poly-L-arginine+poly-L-glutamate, respectively. After 7 days, the extent of adhesion formation was determined during relaparotomy and was expressed as the mean percentage of the total wound length. Results. A significant decrease (p <0.001) in the peritoneal adhesion rate was detected in all groups, with the exception of the group administered poly-L-arginine. Among those animals that received poly-L-lysine and poly-L-glutamate, the low dose of poly-L-lysine administration resulted in the most pronounced anti-adhesive effect. Conclusions. The most effective polypeptide combination was poly-L-lysine and poly-L-glutamate, also showing effectiveness when used at low doses and by local application. The differences in adhesion prevention and the possible underlying mechanisms are discussed and the key role of poly-L-lysine is elucidated.     

肿瘤标记物结合病理对结直肠癌腹膜转移预判的研究

目的探讨血清CEA、CA19-9、CA125结合临床病理对术前判断是否具有结直肠癌腹膜转移的意义。 方法选取2014年1月至2017年10月在哈尔滨医科大学附属第二临床医学院行手术治疗的结肠癌及肿瘤位于直肠腹膜反折以上的直肠癌患者,共1 215例。其中,无腹膜转移的患者988例,同时性腹膜转移的患者227例,比较两组临床资料。 结果高分化腺癌、中分化腺癌、低分化腺癌、黏液腺癌、印戒细胞癌发生腹膜转移的几率分别为0、5.4%、35.6%、45.3%、75%,病理恶性程度越高越容易出现腹膜转移。血清CEA、CA19-9及CA125三者对结直肠癌腹膜转移的辅助诊断中,以CA125最为敏感,敏感度为100%,曲线下面积为0.897,CA125的这两项明显高于CEA及CA19-9,其特异度与CEA接近,较CA19-9低。CA19-9的特异度最高,为86%,但其灵敏度（47%）、曲线下面积（0.669）为三者中最低。CEA、CA19-9、CA125增高越明显,发生腹膜转移的几率就越大,当CEA＋CA125增高或CA125＋CA19-9增高或CEA＋CA125＋CA19-9增高时,发生腹膜转移的几率分别为65.7%、73.1%、77.3%。 结论通过CEA、CA19-9、CA125结合临床病理等检查的辅助,可以提高术前诊断结直肠癌腹膜转移的准确率,有助于术前判断患者的病情及预后。