蒸馏水清除原发性肝癌切除术中腹腔脱落癌细胞的量效关系  

Dose effect relationship of the stilled water with the elimination of the exfoliated cancer cells in the peritoneal cavity during hepatocellular carcinoma resection

作　　者：徐继[1] 喻晓芬[1] 马英玉[2] 邵钦树[1] 

机构地区：[1]浙江省人民医院胃肠胰外科,杭州310014 [2]浙江省人民医院实验室

出　　处：《中华医学杂志》2016年第46期3702-3705,共4页National Medical Journal of China

基　　金：浙江省科学技术厅2015年度省公益性技术应用研究计划项目（2015C33153）

摘　　要：目的探讨温热蒸馏水清除116例原发性肝癌切除术中腹腔内脱落癌细胞的量效关系。方法对2012年1月—2015年12月手术治疗的116例原发性肝癌手术患者于肿瘤切除前后检测腹腔脱落癌细胞阳性率；关腹前用43～45℃蒸馏水1500ml／次冲洗腹腔后，用37℃无菌生理盐水200ml行腹腔灌洗并收集灌洗液，分别检测腹腔脱落癌细胞阳性率。结果≤10cm肿瘤切除前后腹腔脱落癌细胞无显著变化（均P〉0．05）；〉10cm肿瘤相比切除前，切除后腹腔脱落细胞显著增加（〉10-≤15cm组，P=0．044；〉15（3m组，P=0．033），随着肿瘤体积的增大，肿瘤切除后肿瘤脱落细胞显著增加（P〈0．001），冲洗后残留率增加，〉10cm的肿瘤随着冲洗次数增加，残留率显著下降（〉10～≤15cm组，P=0．002；〉15cm组，P=0．001），4次冲洗后检测不到残留。≤5cm肿瘤随着冲洗次数增加残留率下降不明显（P〉0．05），但均在第3次冲洗后未检测到残留。结论彻底清除原发性肝癌术中腹腔脱落癌细胞的冲洗量与肿瘤体积明显相关。Objective The aim of the study was to investigate the dose effect relationship of warm distilled water to remove the exfoliated cancer cells （ECC） in peritoneal cavity in 116 cases of hepatocellular carcinoma. Methods Positive rates of exfoliated cancer cells in 116 patients with hepatocellular carcinoma were detected before and after the removal of the tumor. The 43 to 45 ℃ distilled water was used by 1 500 ml/time before closing the abdomen, and then 37℃ sterile normal saline 200 ml was used for peritoneal lavage and collected for exfoliated cancer cell detection. Results Positive rates of ECC had no significant difference before and after resection in groups with tumor diameter ≤ 10 cm （ all P 〉 0. 05 ） ; positive rates of ECC were significantly increased after tumor resection in groups with tumor diameter 〉 10 cm （ ≤15 cm, 〉 10 cm, P =0. 044; 〉 15 cm, P =0. 033）. With the increase of tumor volume, ECC positive rates were significantly increased after resection （P 〈 0. 001 ） , and the residual rate increased after washing; the residual rates was significantly decreased with the increasing of irrigation times in groups with tumor diameter 〉10 cm （≤15 cm, 〉10 cm, P=0.002; 〉15 cm, P=0.001）, and undetectable after four times washing. With the increase of irrigation times, the residual rates were not significantly decreased （ all P 〉 0.05 ） in groups with tumor diameter ≤ 5 cm, but no residue was detected after three times of washing. Conclusion The volume of irrigation needed to eliminate the ECC in the peritoneal cavity during the operation of hepatocellular carcinoma is significantly correlated with the tumor size.

关 键 词：原发性肝细胞癌 腹腔脱落癌细胞 量效关系 

分 类 号：R735.7[医药卫生—肿瘤]