不同浆膜受侵犯面积胃癌患者行腹腔镜胃癌根治术对腹腔微转移的影响  

Effects of laparoscopic radical gastrectomy on the peritoneal micrometastases of gastric cancer in patients with serosal invasion

作　　者：张帆[1] 郝迎学[1] 唐波[1] 赵永亮[1] 石彦[1] 钱锋[1] 李平昂[1] 余佩武[1] 

机构地区：[1]第三军医大学西南医院全军普通外科中心微创胃肠外科中心,重庆400038

出　　处：《中华消化外科杂志》2015年第5期400-404,共5页Chinese Journal of Digestive Surgery

基　　金：重庆市科技攻关计划项目（CSTC2012ggyyjs10029）

摘　　要：目的 探讨不同浆膜受侵犯面积胃癌患者行腹腔镜胃癌根治术对腹腔微转移的影响.方法 回顾性分析2012年10月至2014年10月第三军医大学西南医院收治的114例行腹腔镜胃癌根治术的胃癌患者的临床资料.收集患者腹腔冲洗液和手术切除的胃组织标本进行研究.应用AutoCAD软件计算患者手术切除胃组织标本的浆膜受侵犯面积.浆膜未受侵犯患者32例,设为A组;浆膜受侵犯面积＜5 cm2患者30例,设为B组;浆膜受侵犯面积为5∽10 cm2患者27例,设为C组;浆膜受侵犯面积＞ 10 cm2患者25例,设为D组.B、C、D组患者为T4a期胃癌.采用荧光定量RT-PCR法检测腹腔冲洗液中CEA mRNA和多巴脱羧酶（DDC）mRNA相对表达量.采用门诊及电话方式进行随访,随访时间截至2015年4月.计数资料采用χ2检验.符合正态分布的计量资料以（x）±s表示,多组间比较采用方差分析,手术前后比较采用重复测量的方差分析.采用Kaplan-Meier法绘制生存曲线,Log-rank检验进行生存分析.结果 A组、B组、C组及D组患者术前腹腔冲洗液中CEA mRNA的相对表达量分别为0.172±0.013、0.194±0.017、0.221 ±0.018、0.256±0.021,术后CEA mRNA的相对表达量分别为0.199±0.012,0.217±0.018、0.245±0.012、0.565 ±0.026;4组患者术前腹腔冲洗液中DDC mRNA的相对表达量分别为0.186±0.011、0.227±0.021、0.244±0.019、0.268±0.025,术后DDC mRNA的相对表达量分别为0.213±0.018、0.257±0.020、0.281±0.024、0.573±0.049.4组患者术前CEA mRNA、术后CEA mRNA、术前DDC mRNA、术后DDCmRNA比较,差异均有统计学意义（F=291.865,397.488,289.541,381.769,P＜0.05）.进一步分析：A组、B组、C组术前腹腔冲洗液中CEA mRNA的相对表达量与术后比较,差异均无统计学意义（F=1.651,0.681,1.381,P＞0.05）;D组术前腹腔冲洗液中CEA mRNA的相对表达量与术后比较,差异有统计学意义（F=46.228,P＜0.05）.A组、B组、C组术前腹腔冲洗液中DDC mRNA的相对�Objective To investigate the effects of laparoscopic radical gastrectomy on the peritoneal micrometastases of gastric cancer in patients with serosal invasion.Methods The clinical data of 114 patients with gastric cancer who underwent laparoscopic radical gastrectomy at the Southwest Hospital between October 2012 and October 2014 were retrospectively analyzed.The peritoneal irrigation fluids and tissue specimens from surgical resection were collected,respectively.The area of serosal invasion in the tissue specimens was calculated by AutoCAD software.There were 32 patients without serosal invasion （A group）,30 patients with the area of serosal invasion 〈 5 cm2 （B group）,27 patients with the area of serosal invasion≥5 cm2 and ≤ 10 cm2 （C group） and 25 patients with the area of serosal invasion 〉 10 cm2 （D group）.The patients of the B,C and D groups were confinned in the T4a stage of gastric cancer.The relative expressions of carcinoembryonic antigen （CEA） mRNA and dopa decarboxylase （DDC） mRNA in the peritoneal irrigation fluids were detected by the fluorescent quantitative real-time PCR （RT-PCR）.The follow-up by outpatient examination and telephone interview were done up to April 2015.The count data were analyzed by the chi-square.The measurement data with normal distribution were presented as （x） ± s.The comparison among groups was analyzed using the ANOVA.The preoperative and postoperative comparisons were analyzed by the repeated measures ANOVA.The survival curve was drawn by Kaplan-Meier method,and the survival analysis was done using the Log-rank test.Results The relative expressions of CEA mRNA in the preoperative peritoneal irrigation fluids in the A,B,C and D groups were 0.172 ±0.013,0.194 ±0.017,0.221 ± 0.018 and 0.256 ± 0.021,respectively.The relative expressions of CEA mRNA in the postoperative peritoneal irrigation fluids in the A,B,C and D groups were 0.199 ±0.012,0.217 ±0.018,0.245 ±0.012and 0.565 ± 0.026,respectively.The relative expressions of DDC mR

关 键 词：胃肿瘤 腹腔镜检查 腹腔冲洗液 癌胚抗原 多巴脱羧酶 

分 类 号：R735.2[医药卫生—肿瘤]