术前动脉灌注化疗加栓塞对cT3~4NxM0期胃癌患者腹腔脱落癌细胞的影响  

Influence of cancer cells exfoliation in operation with preoperative infusion chemotherapy and embolization for cT3~4NxM0 gastric cancer

作　　者：贺通 王黔 王海斌 严芝强 谢海涛 刘文甜 He Tong;Wang Qian;Wang Haibin;Yan Zhiqiang;Xie Haitao;Liu Wentian(Department of Gastrointestinal Surgery,Guzhou Medical University.Guiyang 550004,Guizhou,China)

机构地区：[1]贵州医科大学附属医院胃肠外科,贵州贵阳550004

出　　处：《贵州医药》2020年第7期1017-1020,共4页Guizhou Medical Journal

基　　金：贵州省科技计划项目[黔科合SZ字(2014)3021号]。

摘　　要：目的通过收集cT3~4NxM0期胃癌患者开腹后及关腹前腹腔冲洗液分别行细胞学检测(peritoneal lavage cytology,PLC),探讨术前动脉灌注化疗加栓塞治疗对cT3~4NxM0期胃癌患者腹腔癌细胞脱落的影响。方法回顾性分析贵州医科大学附属医院胃肠外科2014年2月至2015年12月收治的胃癌患者,均经胃镜活检证实,常规行胸片及胃低张增强CT检查,无远隔脏器转移征象,临床分期为T3~4NxM0期,依据本研究纳入标准和排除标准,最终共73例患者入组本研究,其中介入组31例,对照组42例。介入组患者均采Seldinger法,经股动脉穿刺放入导管,行动脉灌注化疗加胃动脉栓塞术。介入术后14 d行手术治疗。对照组直接手术。均在开腹后和关腹前予300 mL温生理盐水行腹腔冲洗,冲洗后立即收集腹腔冲洗液,行离心、涂片,每份冲洗液涂片6张,行瑞氏染色后用光学显微镜找癌细胞。结果介入组开腹后腹腔冲洗液中,PLC检测脱落癌细胞的阳性率9.7%(3/31),低于对照组中开腹后腹腔脱落癌细胞的阳性率35.7%(15/42),差异有统计学意义(P=0.011)。介入组的开腹后脱落癌细胞阴性例数28例中关腹前阳性例数1例,对照组中开腹后脱落癌细胞阴性例数27例中关腹前阳性例数7例(P=0.049)。结论胃癌手术过程中可造成癌细胞的医源性播散。术前动脉灌注化疗加栓塞可减少cT3~4NxM0期胃癌腹腔内癌细胞的脱落,同时可降低术中癌细胞的医源性播散。Objective To explore the effect of cancer cells detachment in operation with infusion chemotherapy and embolization by collected the peritoneal lavage fluid after open surgery and tumor resection by peritoneal lavage cytology respectively for patients who develop advanced gastric cancer.Methods Total of 73 patients with advanced gastric cancer was enrolled from February 2014 to December 2015.They were all confirmed gastric cancer by endoscopic biopsy and pathology.Routine X-ray test and hypotonic CT showed no transfer signs in liver and other parts of them,whose clinical stage were T3,T4.Introduced the treatment to the patients,those who have no serious systemic contraindications can were interventional therapy voluntarily and be assigned to interventional treatment group.The patients were inserted a connecting conduct into artery via femoral artery puncture and undergo selective arteriography by Seldinger method.After that,the patients received intra-arterial chemotherapy and gastric arterial embolization.After 14 days intervention,the surgery came.The peritoneal lavage fluid was checked after open surgery and tumor resection by peritoneal lavage cytology respectively.After sedimentation and centrifugali-zation,each kinds of the lavage fluid were made into 6 flakes and performed Switzerland′s dyeing and then used an optical microscope to find cancer cell.Over the same period,there were 42 advanced gastric cancer patients undergoing routine surgery as a control group.Used the same method to collect peritoneal lavage fluid and compare the two groups about positive rate of exfoliative cancer cells.Results In the preoperative peritoneal wash of the intervention group,positive rate of detachment of cancer by PLC detection was 9.7%(3/31)lower than that 35.7%(15/42)of control group.There were statistical significantly differences(P=0.011)with Fisher′s Exact Text.Among the intervention group,there was only one case that the preoperative detachment of cancer cell was negative but positive after operation which was le

关 键 词：进展期胃癌 介入 灌注化疗加栓塞 腹腔冲洗液 腹腔脱落癌细胞 细胞学检测 

分 类 号：R735.2[医药卫生—肿瘤]