胃癌患者血中游离癌细胞CK-20 mRNA检测的临床意义

目的：探讨胃癌患者手术前后血中游离癌细胞CK-20 mRNA的检测情况及临床意义。方法：采用RT-PCR方法，检测40例胃癌患者及20例胃、十二指肠良性疾病患者手术前后血中游离癌细胞CK-20 mRNA表达。结果：胃、十二指肠良性疾病组CK-20 mRNA表达均为阴性，胃癌组术后CK-20 mRNA表达阳性率(37.5%，15/40)明显高于术前(22.5%，9/40)（P<0.05）。术中先结扎肿瘤周围回流静脉组（A组）术后CK-20 mRNA表达阳性率为35%，不结扎回流静脉组（B组）术后阳性率为40%，二组比较差异无显著性（P>0.05）。CK-20 mRNA阳性检出率与胃癌分化程度无明显相关性（r=0.012, P>0.05），与Bormann分型亦无明显相关性（r=0.024，P>0.05）。结论：进展期胃癌术前已有部分患者血中存在游离癌细胞，手术 中的牵拉刺激可增加癌细胞血行播散的可能性，术中单纯靠结扎回流静脉的方法无法完全阻断癌细胞播散入血。

Detection of free cancer cell CK-20 mRNA in peripheral blood in patients with gastric carcinoma

Objective To explore the clinical significance of detection of free cancer cell CK-20 mRNA in peripheral blood in patients with gastric carcinoma before and after operation. Methods CK-20 mRNA levels of free cancer cells in peripheral blood in 40 patients with gastric cancer and 20 cases of benign disease of stomach and duodenum before and after operation were determined with PCR technique.Results CK-20 mRNA did not express in the benign disease group.The positive expression rate of CK-20 mRNA was 22.5%(9/40) in gastric cancer group before operation and the positive rate was 37.5%(15/40) after operation (P<0.05).The positive rate of CK-20 mRNA after operation in group A (peripheral veins were ligated around stomach at first) was 35%,and in group B( peripheral veins were not ligated around stomach) was 40%,there was no significant difference between group A and group B(P>0.05).The positive expression of CK20 mRNA has negative correlation with degree of differentiation and Bormann typing(r=0.012,P>0.05;r=0.024,P>0.05)Conclusion There are some free cancer cells in the prepheral blood of some patients with gastric cancer before operation. Pulling and stimulating tumor in the operation may increase cancer cell dissemination.Simple ligation of peripheral veins around stomach could not completely prevent cancer cell dissemination in the peripheral blood.