152例非小细胞肺癌术中胸腔冲洗细胞学分析

[目的]探讨无胸腔积液的非小细胞肺癌术中胸腔冲洗细胞学的特点。[方法]无胸腔积液的非小细胞肺癌．在手术刚开胸时以80ml生理盐水冲洗胸腔，收集冲洗液即刻作细胞学分析。[结果]共完成152例肺癌胸腔冲洗细胞学分析，发现癌细胞18例，阳性率为11．8％：可疑癌细胞6例．可疑阳性率为3．9％。冲洗细胞学结果仅与是否有胸膜受侵相关（P=0．026）。[结论]无胸腔积液的非小细胞肺癌包括Ⅰb期、Ⅱb期病变．术中胸腔冲洗细胞学有较高的阳性率和可疑阳性率。受侵胸膜表面癌细胞的脱落并非是冲洗细胞学阳性的惟一原因。     

肺癌术中胸腔冲洗液细胞学的临床意义

目的：研究术中胸腔冲洗液细胞学检测对肺癌患者的预后价值。方法：无恶性胸腔积液的100例肺癌患者，剖胸后及术毕胸膜腔冲洗，冲洗液行病理细胞学检查，术后患者随访。结果：冲洗液细胞学检测：术前阳性8例．术后阳性5例。3年生存率随访：冲洗液细胞学阳性者为20％，阴性者为60％。冲洗液阳性的相关因素包括：病理分期、细胞类型、肿瘤大小、胸膜侵犯程度。结论：术中胸膜腔冲洗液细胞学检查可提示胸膜腔的微转移，是一个重要的预后因素。     

DNA倍体分析在胸腹水诊断中的价值

目的探讨流式细胞术(FCM)DNA倍体分析对恶性胸腔积液及腹水的诊断价值.方法以57例患者的胸水或腹水作流式细胞术DNA倍体分析和脱落细胞学检测,比较二者之间的敏感性和特异性.结果FCM、脱落细胞学检测在良恶性胸腔积液或腹水中的阳性率分别为6.67%,62.96%;3.33%,48.15%.二种方法均有非常显著性差异(P＜0.01).FCM、脱落细胞学检测在恶性胸腔积液或腹水中敏感性分别为62.96%,48.15%,二者无显著性差异(P＞0.05).特异性分别为93.33%,96.67%,二者无显著性差异(P＞0.05).结论流式细胞术分析胸腔积液及腹水细胞的DNA异倍体,对于恶性肿瘤的细胞学诊断有重大意义.     

痰液细胞DNA含量分析对肺癌的诊断价值

目的　探讨痰液细胞DNA含量分析对肺癌的诊断价值。方法　用流式细胞仪对 44例患者 ( 2 9例肺癌、15例肺良性疾病患者 )痰液细胞DNA含量进行分析 ,并与痰细胞形态学检查结果作比较。对痰细胞学阴性而DNA含量分析阳性的对照患者组织切片行 p5 3、PCNA、Ki67免疫组化分析。 结果　以最后病理诊断为标准 ,肺癌患者异倍体检出的敏感性为 82 .8%,显著高于痰细胞学的敏感性 ( 2 7.6%) (P <0 .0 0 5 ) ;肺癌晚期异倍体阳性率高于早期肺癌 ( 87.5 %比 76.9%,P <0 .0 0 2 5 ) ,其中 1例肺癌患者提前临床 10月检出异倍体。部分炎性假瘤及结核球患者痰标本检出异倍体 ,其相应的组织切片PCNA、Ki67免疫组化染色亦阳性。结论　痰液细胞DNA含量分析是肺癌诊断有效的辅助方法 ,可能有利于肺癌的早期诊断。部分炎性假瘤及结核球存在细胞增殖异常     

进展期胃癌患者手术前后脱落细胞及DNA异倍体阳性率分析

摘 要：［目的］分析进展期胃癌患者手术前后腹腔灌洗液脱落细胞及DNA异倍体阳性率。［方法］ 选择接受治疗的进展期胃癌患者201例,分别采用腹腔镜（101例）和开腹下行胃癌D2根治术（100例）,在手术前后分别取腹腔灌洗液,并对其进行腹腔灌洗液细胞学（peritoneal lavage cytology）即PLC检查,使用Feulgon染色,检测其脱落细胞及DNA异倍体阳性率。［结果］ 腹腔镜组术前腹腔灌洗液脱落细胞的检测阳性率为20.79%(21/101),DNA异倍体阳性率为28.71%（29/101）;开腹组术前肿瘤腹腔灌洗液中脱落细胞阳性率为18.00%(18/100),DNA异倍体阳性率为28.00%（28/100）,组间比较差异均无统计学意义。腹腔镜组术后腹腔灌洗液脱落细胞阳性率显示为9.90%(10/101),DNA异倍体阳性率为17.82%（18/101）,开腹组腹腔灌洗液脱落细胞的阳性率 9.00%(9/100),DNA异倍体阳性率为17.00%(17/100),与腹腔镜组患者相比差异均无统计学意义。腹腔镜组手术前后PLC和DNA异倍体的阳性率Ⅱ期均低于Ⅲ期,差异有统计学意义（P＜0.05）;开腹组手术前后PLC和DNA异倍体阳性率Ⅱ期均低于Ⅲ期,差异有统计学意义（P＜0.05）。［结论］ DNA异倍体的检测结果阳性率高于PLC,腹腔镜下和开腹下胃癌D2根治术的治疗效果相近。     

应用流式细胞术检测胃癌患者术中腹腔冲洗液脱落细胞的临床研究

  目的  应用流式细胞技术(flow cvtometry, FCM)对腹腔冲洗液进行DNA倍体分析, 作为胃癌腹腔脱落癌细胞(exfoliat-ed canceF cells, , ECC)检测的辅助手段为临床提供依据。  方法  收集62例胃癌患者术中腹腔冲洗液, 应用FCM进行脱落细胞DNA倍体分析, 同时行腹腔冲洗液细胞学(peritoneal lavage eytologv, PLC)检查, 比较二者的检测敏感度, 并分析FCM与胃癌不同临床病理特征的相关性。  结果  62例胃癌腹腔冲洗液流式细胞术DNA倍体分析检测阳性率为67.74%, 而PLC阳性率仅为33.87%, 两组差异有统计学意义(P < 0.001)肿瘤类型、浸润深度、受侵面积、淋巴结转移、脉管瘤栓、TNM分期与腹腔冲洗液异倍体肿瘤细胞相关(P均 > 0.05)在局限性胃癌、肿瘤浸润深度、浆膜受侵面积 < 10cm2、淋巴结转移、无脉管瘤栓、TNM分期方面腹腔冲洗液FCM检测阳性率优于PLC(P均 > 0.05)。  结论  流式细胞术可作为胃癌患者术中检测ECC的有效辅助诊断手段。      

术中胸腔冲洗液细胞学检查及对预后影响的研究

术中胸腔冲洗液细胞学检查及对预后影响的研究王彩凤许凝本钢胸科医院胸外科（本溪１１７０２１）本文对２０例肺癌开胸后未做任何处置前（包括探查），无肉眼所见胸腔积液的患者，立即取生理盐水２００ｍｌ冲洗胸腔，然后收集冲洗液放入离心管中，将标本以２０００转／分...     

术中胸膜腔冲洗液细胞学及CEA检测对NSCLC胸膜腔微转移预测价值分析

目的:探讨术中胸膜腔冲洗液细胞学及癌胚抗原(CEA)联合检测对非小细胞肺癌(NSCLC)胸膜腔微转移的预测价值.方法:对50例肺癌患者进行术中胸膜腔冲洗,检测冲洗液中游离的肿瘤细胞,同时采用电化学免疫发光技术检测冲洗液中CEA的水平.40例肺良性疾病者作为对照.结果:40例肺良性疾病者胸膜腔冲洗液细胞学全部阴性,冲洗液中CEA的浓度均＜0.3 ng/mL.肺癌组5例(10.0％)患者胸膜腔冲洗液细胞学阳性,冲洗液中CEA水平反而正常.45例胸膜腔冲洗液细胞学阴性的患者中有27例(54.0％)患者胸膜腔冲洗液CEA水平升高.冲洗液CEA水平与患者的病理分期(P=0.019)、淋巴结分期(P＜0.01)、T分期(P=0.003)、冲洗液细胞学(P=0.037)及血清CEA水平(P=0.002)密切相关;与患者的年龄、性别及病理组织类型无明显相关性,P＞0.05.胸膜腔灌洗液中细胞学及CEA水平对预测NSCLC胸膜腔微转移的敏感性分别为10.0％(5/50)和54.0％(27/50).两者联合检测的敏感性为64.0％(32/50),显著高于单项检测,P＜0.01.结论:采用冲洗液CEA水平预测NSCLC胸膜腔微转移比细胞学检测更有意义,联合检测可以提高NSCLC胸膜腔微转移的阳性率.     

流式细胞术在胸腔积液及腹水细胞诊断中的价值

目的 :探讨DNA异倍体对于伴有胸腔积液及腹水肿瘤的诊断价值。方法 :将临床上出现中等量以上胸腔积液或腹水的 5 5例患者 ,抽取胸腔积液或腹水 ,分离其中的细胞 ,制备单细胞悬液 ,用流式细胞仪分析DNA异倍体 ,并探讨其与病理诊断及临床诊断的关系。结果 :DNA异倍体在肿瘤细胞中出现率显著高于非肿瘤细胞 ,统计学检验表明两者差异有显著性。结论 :流式细胞术分析胸腔积液及腹水细胞的DNA异倍体 ,对于恶性肿瘤的细胞学诊断有较大的意义 ,可在临床推广应用     

流式细胞术在胸腔积液及腹水细胞诊断中的价值

目的：探讨DNA异倍体对于伴有胸腔积液及腹水肿瘤的诊断价值。方法；将临床上出现中等量以上胸腔积液或腹水的55例患者，抽取胸腔积液或腹水，分离其中的细胞，制备单细胞悬液，用流式细胞仪分析DNA异倍体，并探讨其与病诊断及临床诊断的关系。结果：DNA异倍体在肿瘤细胞中出现率显著高于非肿瘤细胞，统计学检验表明两者差异有显著性。结论：流式细胞术分析胸腔积液及腹水细胞的DNA异倍体，对于恶性肿瘤的细胞学诊断有较大的意义，可在临床推广应用。     

Pleural Lavage Cytology Immediately after Thoracotomy as a Prognostic Factor for Patients with Lung Cancer

Pleural lavage cytology was examined in 230 lung cancer patients just after opening the chest. There were 16 cases (7.0%) of positive pleural lavage cytology, and the results of pleural lavage cytology were related to the presence of pleural involvement by cancer, microscopical pleural dissemination and lymphatic permeation of the cancer cells. If the cancer involves the pleura or lymphatics of the submesothelial layer, being covered with visceral mesothelium, positive cytology may still be obtained. Pleural lavage cytology at opening of the chest seems to be available as a premonitory indicator for exfoliation and dissemination into the pleural cavity or subpleural lymphatic extension of cancer cells, and it was suggested that positive pleural lavage cytology has an influence on postoperative survival.     

Pleural lavage cytology immediately after thoracotomy as a prognostic factor for patients with lung cancer

Pleural lavage cytology was examined in 230 lung cancer patients just after opening the chest. There were 16 cases (7.0%) of positive pleural lavage cytology, and the results of pleural lavage cytology were related to the presence of pleural involvement by cancer, microscopical pleural dissemination and lymphatic permeation of the cancer cells. If the cancer involves the pleura or lymphatics of the submesothelial layer, being covered with visceral mesothelium, positive cytology may still be obtained. Pleural lavage cytology at opening of the chest seems to be available as a premonitory indicator for exfoliation and dissemination into the pleural cavity or subpleural lymphatic extension of cancer cells, and it was suggested that positive pleural lavage cytology has an influence on postoperative survival.     

Prognosis of non-small cell lung cancer patients with positive pleural lavage cytology after a thoracotomy: results of the survey conducted by the Japan Clinical Oncology Group

OBJECTIVE: The purpose of this study was to clarify the prognosis of non-small cell lung cancer patients without pleural effusion whose intrapleural cancer cells were detected by a cytologic examination of pleural lavage fluid obtained immediately after a thoracotomy. METHOD: A questionnaire survey on the survival of the patients with positive pleural lavage cytology from January 1985 to December 1994 was performed by the Japan Clinical Oncology Group. RESULTS: According to the data collected from 15 institutions, 1890 non-small cell lung cancer patients without pleural effusion underwent pleural lavage cytology immediately after thoracotomy and 142 (7.8%) of them were found to have intrapleural cancer cells detected by the cytological analysis. The information of survival on 113 patients was available. This comprised of 64 males and 49 females with a mean age of 64.6 years. The predominant histologic type was adenocarcinoma (74%). Out of these 113 patients, 109 (97%) underwent a surgical resection. The 5-year survival rate was 30% in all patients, 49% in pathological stage I (n=35), 23% in stage II (n=20) and 26% in stage IIIA (n=34). CONCLUSION: Patients with a positive pleural lavage cytology in pathological stage I or II appear to have a poor 5-year survival rate.     

术中胸腔冲洗液查瘤细胞在肺癌手术中的应用进展

肺癌是目前常见的恶性肿瘤,预后较差,大多患者发现时即已发生转移。目前临床上的常规检查方法难以判断肺癌是否发生胸膜腔微转移,而冲洗胸腔后在冲洗液中找到瘤细胞则可以证明肺癌已经发生了胸膜腔微转移,这种方法可以评估肺癌分期,并且为后续的治疗提供依据。本文将针对胸腔冲洗液查瘤细胞的研究进展和应用作一综述。     

肺癌术中冲洗液细胞学检查与腔内温热灌注化疗疗效研究

目的:检测无胸水肺癌患者胸膜腔内在术前或术后是否存在游离癌细胞并探讨术中低渗水热灌注化疗和低渗热灌注治疗对生存期的影响.方法:对380例无胸水肺癌患者术中均在开胸后和关胸前用500ml生理盐水冲洗胸腔,然后留取冲洗液作细胞学检查.阳性者随机分为A组、B组和C组,A组关胸前应用43℃蒸馏水500ml加顺伯(80mg)灌注化疗,B组应用43℃蒸馏水500ml温热灌注,C组未给予治疗常规关胸.结果:阳性患者108例(28.6％),其中腺癌73.2％,磷癌16.7％,其它10.1％,Ⅰ期、Ⅱ期、Ⅲ期的比例分别为2.8％、7.4％、89.8％.A组、B组与C组1、3、5生存率分别为97.4％、76.3％、57.9％；94.4％、69.4％、44.4％；97.1％、38.2％、20.6％.结论:无胸水肺癌患者胸膜腔内在术前或术后有游离癌细胞存在,以腺癌和Ⅲ期的患者居多.术中低渗热灌注化疗和低渗热灌注治疗能提高阳性肺癌患者的3年、5年生存率,但两种治疗方法统计学无显著差异.     

Modified intrapleural cisplatin treatment for lung cancer with positive pleural lavage cytology or malignant effusion

OBJECTIVES: We evaluate the efficacy and safety of the modified intrapleural cisplatin treatment for lung cancer patients with positive pleural lavage cytology or malignant effusion. METHODS: The treatment was performed for seven patients with malignant effusion and 18 patents with positive pleural lavage cytology. After pulmonary resection, the pleural cavity was filled with cisplatin with a normal saline solution for 30 min. Complications and survival of the patients were evaluated. RESULTS: The chest tube duration were significantly prolonged in the treatment (CDDP) group (5.7 +/- 3.6 vs. 2.8 +/- 2.6 days). We had one operative death that developed a bronchial fistula; however, the other complications were not severe. The mortality rate was 4% and the morbidity rate was 60%. We experienced two carcinomatous pleuritis in the CDDP group. The median survival time of the CDDP group was 47.0 +/- 11.1 months and the 3- and 5-year survival rate was 52.6% and 11.3%, respectively. CONCLUSIONS: We were able to perform this treatment for these advanced lung cancer patients, which had the preventive effect of carcinomatous pleuritis. This therapy shows the possibility of a treatment that might lead to an improvement in the prognosis of these patients, without causing severe complications.     

癌性胸水p16基因纯合性缺失检测的临床意义

研究癌性胸水Ｐ１６基因纯合性缺失检测的临床意义。方法：应用ＰＣＲ技术检测胸水Ｐ１６基因第一、二外显子纯合性缺失，并结合胸水脱落细胞学检测分析其在临床诊断中的意义。结果表明所检３１例肺癌所致癌性胸水标本中均无出现Ｐ１６基因第一外显子纯合性缺失，１２例有Ｐ１６基因第二外显子纯合性缺失，阳性率为３８．７１％。     

Clinical Impact and Reliability of Carbonic Anhydrase XII in the Differentiation of Malignant and Tuberculous Pleural Effusions

Objective: To assess the practical utility of pleural fluid carbonic anhydrase XII (CAXII) quantification fordifferential diagnosis of effusions. Materials and Methods: Fluid was collected prospectively from fifty patientspresenting with lymphocytic pleural effusions for investigation and CAXII was quantified by ELISA. Results:Pleural fluid CAXII concentrations were significantly higher in lung cancer patients (n=30) than in tuberculouscontrols (n=20). The sensitivity and specificity of this biomarker were 60%and 75%, respectively. CAXIImeasurement was not inferior to cytological examination in the diagnosis and exclusion of pleural effusionsfrom lung cancer patitents (sensitivity 60% vs. 57%; specificity 75% vs. 100%; positive predictive value 77%;negative predictive value 54%). In patients with negative cytology, it offered a sensitivity of 54%. Conclusions:Pleural fluid CAXII is elevated in pleural effusions from lung cancer patients. Measurement of CAXII may beused in the future as a valuable adjunct to cytology in the diagnostic assessment of patients with pleural effusionsrelated to lung cancer, especially when cytological examination is inconclusive.     

检测肿瘤标志物ProGRP、NSE、CYFRA21-1、CEA对胸腔积液鉴别诊断价值的研究

背景与目的 恶性胸腔积液多由肺癌引起，肿瘤标志物检测对其鉴别诊断有一定临床价值。本研究的目的是探讨血清及胸腔积液胃泌素前体释放肽片断31—98（ProGRP）、神经元烯醇化酶（NSE）、细胞角蛋白19（cYFRA21—1）和癌胚抗原（CEA）单项或联合检测对肺癌所致恶性胸腔积液鉴别诊断与组织学分型的临床价值。方法 将肺癌所致的恶性胸腔积液患者按原发肿瘤类型分为小细胞肺癌（SCLC）组、肺腺癌组及肺鳞癌组，同时以良性胸腔积液组、健康对照组作为对照。评估胸腔积液ProGRP、NSE、CYFRA21—1和CEA单项及联合检测对各组恶性胸腔积液的诊断价值。结果 血清及胸腔积液ProGRP、NSE、CYFRA21—1、CEA在各恶性胸腔积液组的水平均明显高于对照组（P〈0．01）。SCLC组检测胸腔积液ProGRP的Youden指数和诊断准确性最高；肺腺癌和肺鳞癌组则以胸腔积液CEA＋CYFRA21—1联合检测（按平行试验）的Youden指数及诊断准确性最高。结论胸腔积液肿瘤标志物系列（ProGRP、NSE、CYFRA21—1、CEA）检查对恶性胸腔积液的鉴别诊断与组织学分型有很大的临床价值。胸腔积液ProGRP为SCLC所致恶性胸腔积液的最佳肿瘤标志物；胸腔积液cEA＋cYFRA21—1联合检测（按平行试验）为肺腺癌、肺鳞癌所致恶性胸腔积液较好的辅助诊断指标。