术中防止胃癌细胞血行播散的阻断技术及其操作方法  

Newly interrupted techniques and procedures to prevent gastric cancer cells dissemination in the radical resection of gastric cancer

作　　者：胡承恩[1] 甘军[1] 陈妍如[1] 张延龄[1] 黄广建[1] 

机构地区：[1]复旦大学附属华山医院普通外科,上海200040

出　　处：《中国癌症杂志》2010年第7期551-554,共4页China Oncology

摘　　要：背景与目的:胃癌手术过程中的不当可能造成癌细胞的远处转移和腹腔播散种植,本研究旨在介绍一种术中能阻断胃癌细胞血行播散的有效技术。方法:采用胃癌阻断技术对17例患有胃窦癌、胃体癌及贲门癌的患者行术中血流阻断,观察其阻断效果及可能出现的并发症;并初步观察阻断组与常规手术组(未阻断)肝门静脉血内CK19mRNA的表达情况。结果:胃窦癌、胃体癌与贲门癌均顺利地完成血流阻断,但阻断方法稍有不同;阻断过程中需防止刮伤脾包膜,对胃与胰腺粘连者注意防止胃后壁的损伤;17例常规手术组胃癌中,9例肝门静脉血中CK19 mRNA为阳性,而17例阻断组患者肝门静脉血中CK19mRNA均为阴性。结论:胃癌阻断技术是一种简便和安全的操作方法,能有效防止术中癌细胞大量进入肝门静脉系统,有临床推广应用价值。Background and purpose：Inadequate surgical operation of gastric cancer may cause introgenic tumor cell dissemination and peritoneal seeding.This study introduced a new technique of the interrupted procedure to prevent gastric cancer cells dissemination in the radical resection of gastric cancer.Methods：Patients received gastric interrupted procedure employing the use of gastric interrupted forceps in the carcinoma of antrum,gastric body or cardia.The interrupted effect,complicated nature of the procedure and the preliminary result of CK19 mRNA expression in the portal blood by RT-PCR techniques of the interrupted group and the routine operation group were analyzed.Results：All the patients were successfully interrupted in the gastric operation,but there were some differences in the detailed procedure between the carcinoma of antrum,gastric body and cardia.Special attention should be given to the prevention of spleen scrape via the interrupted forceps,and to the posterior gastric trauma in case there is adhesion between the stomach and pancreas.Nine patients （9/17） of the routine operation group have positive portal blood CK19 mRNA expression whereas all 17 patients have negative portal blood CK19 mRNA expression in the interrupted group.Conclusion：The interrupted procedure is an easy,useful and safe method of manipulating and to preventing a large amount of gastric cancer cells from disseminating in the portal blood during the radical operation of gastric cancer.

关 键 词：阻断技术 胃癌 肿瘤转移 肝门静脉 

分 类 号：R730.56[医药卫生—肿瘤] R735.2[医药卫生—临床医学]