腹腔液胃癌细胞学与CEA mRNA检测比较的意义

目的：探讨胃癌病人术中腹腔冲洗液细胞学及腹腔冲洗液、腹膜组织中的癌胚抗原（CEA）mRNA，以探讨对腹腔中游离癌细胞和预测腹膜转移的诊断价值。方法：收集48例胃癌和5例胃良性病变病人的腹腔冲洗液或腹水，并同时切除少量大网膜、膈腹膜和盆腔腹膜作为对照。冲洗液行常规细胞学检查，并逆转录－聚合酶链反应（RT－PCR）法检测腹腔游离癌细胞和网膜组织中CEA mRNA的表达。结果：腹腔冲洗液和腹膜组织中的CEA mRNA的阳性率分别为39．58％（19／48）和43．75％（21／48），皆高于腹腔冲洗液细胞学27．08％（13／48）（P＜0．05）。CEA mRNA的表达与淋巴结转移、肿瘤浸润深度、浆膜侵犯程度及TNM分期呈正相关。结论：腹腔冲洗液CEA mRNA和细胞学检查是检测腹腔游离癌细胞和预测腹膜转移的有效方法；如同时行腹膜组织CEA mRNA的检测可能更有助于诊断。

The Value of CEA mRNA and Cytology in Examination of Peritoneal Washes from Patients with Gastric Cancer

Objective:To investigate the value of intraoperative determination of CEA mRNA and cytologic Examination of free cancer cells in peritoneal washes and CEA mRNA in the peritoneum in diagnosis of peritoneal metastasis in gastric cancer.Methods:The peritoneal washes and peritoneal tissues from the great omentum,diaphragm and pelvic wall were collected during laparotomy in48patients with gastric cancer and5with benign gastric diseases.CEA mRNA by RTPCR and cytology by the conventional method respectively.Results:The CEA mRNA positive rate of peritoneal washes and peritoneal tissues were39.58%and43.75%respectively.Both were more sensitive than that of cytologic examintion(27.08%)(P<0.05).Lymph node metastasis,depth of invasion,serosal involvement and TNM staging were related to the positive rate of CEA mRNA.Conclusions:The combined use of CEA mRNA and cytologic study of peritoneal washes serves better to predict patients who will develop peritoneal metastasis and cancer recurrence.If CEA mRNA in the peritoneal tissues is investigated simultaneously,the sensitivity could be further enhanced.