原发性肝癌患者术中腹腔游离癌细胞的检测及其临床意义  

Detection of intraperitoneal free cancer cells before and after resection of hepatocellular carcinoma during operation

作　　者：张海斌[1] 杨广顺[1] 卢军华[1] 杨宁[1] 宗明[1] 谭璐[1] 

机构地区：[1]第二军医大学东方肝胆外科医院,上海200438

出　　处：《第二军医大学学报》2002年第5期501-503,共3页Academic Journal of Second Military Medical University

基　　金：上海市卫生系统重点发展基金资助项目 (992 D 0 0 2 )

摘　　要：目的 :对原发性肝癌患者腹腔游离癌细胞进行定性研究 ,探讨术后腹腔种植的原因及防治方法。方法 :5 8例原发性肝癌患者 ,取手术中肿瘤切除前后的腹腔灌洗液 ,立即 H - E染色 ,检查游离癌细胞。结果 :进腹后切除前灌洗液发现游离癌细胞者 7例 ,切除前后两次灌洗液中均发现癌细胞者 1例 ,无 1例仅切除后发现癌细胞。结论 :腹腔游离癌细胞阳性的相关因素包括 :(1) TNM分期的 期、 期 ,尤其是 T3、T4 分期 ;(2 )自发性肝癌破裂 ;(3)肿瘤位于肝表面 ,尤其是侵犯包膜 ;(4)腹腔积液≥ 5 0 m l。切除前、后用蒸馏水充分冲洗腹腔临床易于开展 ,对预防和治疗肝癌术后腹腔种植有一定的作用。Objective: To detect the intraperitoneal free cancer cells(IFCC) through intraoperative peritoneal washing cytology, as to study the probable reason of intraperitoneal metastases. Methods: Fifty eight patients with hepatocellular carcinoma underwent operations were included into this study. The washing fluids were collected before and after resection. The specimens were centrifuged and subjected to H E staining as soon as possible. Results:Seven patients were detected positive of IFCC in washing fluid only after opening the abdomen, one patient was positive both preresection and postresection, and none was detected positive only before closing the abdomen. Conclusion: Factors responsible for IFCC in washing solution are:(1) Ⅲ and Ⅳ of TNM category, especially the T 3 and T 4; (2) spontaneous rupture of a hepatocellular carcinoma; (3) tumor just sub envelope of liver, especially invasion of the envelope;(4) more than 50 ml of ascites. Enough distilled water washing preresection and postresection can prevent intraperitoneal metastases after operation.

关 键 词：原发性肝癌 腹腔种植 腹腔游离癌细胞 临床意义 

分 类 号：R735.7[医药卫生—肿瘤]