手术操作对胃癌细胞外周血播散的影响及其危险因素  

Effect of surgical manipulation on the dissemination of cancer cells into peripheral blood in patients with gastric cancer and its risk factor analysis

作　　者：张京平[1] 朱春富[1] 王克俊[1] 徐皓[3] 王仕忠[2] 朱平[1] 高翔[1] 吴文泽[1] 

机构地区：[1]南京医科大学附属常州市第二人民医院普通外科,213003 [2]南京医科大学附属常州市第二人民医院中心实验室,213003 [3]南京医科大学第一附属医院胃肠外科

出　　处：《中华胃肠外科杂志》2007年第3期234-237,共4页Chinese Journal of Gastrointestinal Surgery

基　　金：江苏省常州市卫生科技指导项目（2004）

摘　　要：目的研究手术操作对胃癌细胞外周血播散的影响及其危险因素。方法45例胃癌患者于胃癌根治手术前后即刻分别取外周血，采用RT—PCR的方法测定外周血中癌胚抗原（CEA）mRNA的表达情况。10例健康体检者和3例因胃溃疡而行胃大部切除术者为对照组。结果胃癌患者手术后CEA mRNA阳性率[48．9％（22／45）]显著高于手术前[8．9％（4／45）]（P：0．000）；对照组外周血CEA mRNA的表达皆阴性。手术后CEA mRNA阴性组手术时间（2．46±0．51）h，阳性组则为（3．19±0．48）h，P=0．000；早期胃癌组CEA mRNA阳性率10．0％（1／10），进展期胃癌组CEA mRNA阳性率54-8％（17／31），P=0．034；差异均有统计学意义。多因素Logistic回归分析显示．手术时间和肿瘤侵犯深度为手术后CEA mRNA阳性率升高的危险因素。结论手术操作可导致胃癌肿瘤细胞播散进入血液循环，手术时间和肿瘤侵犯深度为重要的危险因素，随着手术时间的延长和肿瘤侵犯深度的增加，肿瘤细胞播散人血的可能性增加。Objective To evaluate the effect of surgical manipulation on the dissemination of cancer cells into blood circulation in patients with gastric cancer and to analyze its risk factors. Methods This study included 45 consecutive patients with gastric cancer undergoing curative resection and 13 control cases （10 healthy persons and 3 patients with peptic ulcer receiving gastrectomy）. Peripheral blood was obtained preoperatively and just after surgical manipulation, The mRNA levels of carcinoembryonic antigen （CEA） from the blood samples were assayed by reverse transcriptionpolymerase chain reaction（RT-PCR） and compared between the 2 groups. Results CEA mRNA was negative in all control cases. Of the 45 gastric cancer patients, the preoperative positive rate of CEA mRNA was 8.9%, while the postoperative positive rate was 48.9%, which was significantly higher than that of preoperation（P=0.000）. Muhivariable Logistic regression analysis showed that operative duration （P=0.014） and tumor depth （P=0.010） were independent risk factors for cancer cell dissemination. Furthermore, the operative duration in patients with positive postoperative CEA mRNA was markedly longer than that in patients with negative postoperative CEA mRNA （P=0.000）, and positive rate of postoperative CEA mRNA in advanced gastric cancer was higher compared with that in early gastric cancer （P=0.034）. Conclusions Surgical manipulation of curative gastrectomy can provoke dissemination of cancer cells into blood circulation, and the operative duration and tumor invasion depth may be 2 of the risk factors for cancer cell dissemination.

关 键 词：胃肿瘤 手术操作 播散 癌胚抗原 RNA 信使 

分 类 号：R735[医药卫生—肿瘤]