腹腔镜下进展期胃癌根治术中腹腔游离癌细胞检测的意义

目的探讨腹腔镜下进展期胃癌根治术对腹腔脱落肿瘤细胞检测的影响,并探讨提高腹腔游离癌细胞检出率的方法。方法选取华中科技大学同济医学院附属协和医院胃肠外科35例初治的进展期胃癌病人,行腹腔镜下胃癌根治术。所有病人分别在术中探查前及关腹前各行一次腹腔冲洗,并收集灌洗液。比较两组灌洗液中肿瘤脱落细胞阳性检出率及肿瘤标志物上皮膜抗原(epithelial membrane antigen,EMA)、癌抗原(carbohydrate antigen,CA)125、CA19-9和癌胚抗原(carcinoembryonic antigen,CEA)的表达情况。结果35例进展期胃癌病人探查前腹水或腹腔灌洗液中涂片细胞学检查中检出阳性率为5.7%(2/35),关腹前为5.7%(2/35),两者统计比较差异无统计学意义(P>0.05)。免疫组织化学法检测探查前与关腹前腹水或腹腔灌洗液中EMA的表达(4/35,3/35)比较,差异无统计学意义(P>0.05);两个时间点CA125的表达(1/35,3/35)比较,差异无统计学意义(P>0.05)。探查前腹水或腹腔灌洗液中,腹腔灌洗液脱落细胞学法游离癌细胞检出阳性率为5.7%(2/35),而免疫组织化学法检测EMA的阳性率为11.4%(4/35),两者比较差异有统计学意义(P=0.010);免疫组织化学法检测CA125的阳性率为8.6%(3/35),与腹腔灌洗液脱落细胞学法(2/35)比较,差异有统计学意义(P=0.005);免疫组织化学法联合检测EMA及CA125的阳性率为11.4%(4/35),与腹腔灌洗液脱落细胞学法(2/35)比较,差异有统计学意义(P=0.010)。结论腹腔镜下进展期胃癌根治术并不会增加癌细胞脱落风险,且肿瘤脱落细胞发生率低。但腹腔镜下胃癌根治术后腹腔游离癌细胞的诊断,需要更为有效的检测方法。

Detection of the intraperitoneal exfoliated cancer cells in patients with laparoscopic radical gastrectomy for advanced gastric cancer

Objective To study the intraperitoneal exfoliated cancer cells after laparoscopic surgery in the patients of advanced gatric cancer,to explore a method to improve the detection rate of intraperitoneal exfoliated cancer cells.Methods 35 patients with advanced gastric cancer were treated with laparoscopic radical gastrectomy.Among all patients,peritoneal washing was performed once before intraoperative exploration and before abdominal closure,and lavage fluid was collected.The positive rate of tumor exfoliated cells and the expression of tumor markers epithelial membrane antigen(EMA),carbohydrate antigen(CA)CA125,CA19-9 and carcinoembryonic antigen(CEA)in lavage fluid were compared between the two groups.Results The positive rate was 5.7%(2/35)in ascitic fluid and 5.7%(2/35,P>0.05)before abdominal closure in 35 patients with advanced gastric cancer.The expression of EMA and CA125 in ascites and peritoneal lavage fluid was detected by immunohistochemistry before contrast exploration and before closure of the abdomen,both P>0.05.In the ascites or peritoneal lavage fluid before exploration,the positive rate of cancer cells detected by exfoliative cytology was 5.7%(2/35),while the positive rate of EMA detected by immunohistochemistry was 11.4%(4/35,P=0.010,compared with smear cytology),the positive rate of CA125 detected by immunohistochemistry was 8.6%(3/35,P=0.005,compared with smear cytology),and the positive rate of EMA and CA125 detected by immunohistochemistry was 11.4%(4/35,P=0.010,compared with smear cytology).Conclusion Laparoscopic radical gastrectomy for advanced gastric cancer does not increase the risk of cancer cell shedding,and the incidence of tumor exfoliated cells is lower than that of laparotomy.However,the diagnosis of peritoneal free cancer cells after laparoscopic radical gastrectomy requires more effective detection methods.