腹腔镜与开腹结直肠癌根治术对循环血癌胚抗原mRNA含量影响的对比研究  

The Effects of Laparoscopy Versus Open Radical Resection on Circulating CEA mRNA in Patients with Colorectal Cancer

作　　者：陈鸿源[1] 薛芳沁[1] 谢礼锋 许超[1] 王襄瑜[1] 黄良祥[1] CHEN Hongyuan;XUE Fangqin;XIE Lifeng;XU Chao;WANG Xiangyu;HUANG Liangxiang(Provincial Clinical College of Fujian Medical University,Department of Gastrointestinal Surgery,Fujian Provincial Hospital,Fuzhou 350001,China)

机构地区：[1]福建医科大学省立临床医学院,福建省立医院胃肠外科,福州350001

出　　处：《福建医科大学学报》2020年第3期144-149,共6页Journal of Fujian Medical University

基　　金：福建省卫生系统中青年骨干人才培养项目(2014-ZQN-JC-3)。

摘　　要：目的探讨腹腔镜与开腹结直肠癌根治术对循环血癌胚抗原(CEA)mRNA含量影响的差异。方法前瞻性将2018年1—8月诊治的60例结直肠癌患者随机分为腹腔镜组与开腹组,行腹腔镜或开腹结直肠癌D3根治术,分别于手术开始前、手术结束后采集外周静脉(PV)血,于肿瘤游离前及游离后采集肠系膜下静脉(IMV)血,应用实时荧光定量PCR检测,并比较两组患者血细胞中CEA mRNA的阳性表达情况。结果患者术后PV血CEA mRNA的阳性率为31.67%,高于术前的21.67%,但两者差别无统计学意义(P=0.215);肿瘤游离后IMV血CEA mRNA的阳性率为53.33%,显著高于游离前的35.00%(P=0.01)。腹腔镜组患者术前及术后PV血、肿瘤游离前及游离后IMV血的CEA mRNA阳性率分别为23.33%,30.00%及33.33%,50.00%;开腹组则分别为20.00%,33.33%及36.67%,56.67%;两组各对应时间点比较,差别均无统计学意义(P>0.05)。腹腔镜组患者术前及术后PV血、肿瘤游离前及游离后IMV血的CEA mRNA扩增的平均ΔCt值分别为(4.79±0.85),(3.68±0.26),(3.49±0.09)及(1.06±0.23),开腹组分别为(5.03±0.75),(3.37±0.14),(3.37±0.30)及(0.86±0.37),两组各对应时间点比较,差别也均无统计学意义(P>0.05)。结论手术操作可能会增加肿瘤血循环转移的风险,术中应严格遵循“No-Touch”原则。腹腔镜与开腹结直肠癌根治术对循环血CEA mRNA的影响无明显差异。Objective To investigate the effects of laparoscopic versus open radical resection on circulating CEA mRNA in patients with colorectal cancer.Methods From January to August 2018,sixty patients with colorectal cancer treated in our hospital were enrolled prospectively for this research.They were divided into laparoscopy group and the open radical resection group randomly with 30 patients in each group,and then underwent laparoscopy or open radical resection for colorectal cancer.Peripheral vein(PV)blood of the patients was extracted before and after surgery.Inferior mesenteric vein(IMV)blood was extracted before and after dissociation of tumor.The positive rates of CEA mRNA in the blood were detected by polymerase reaction PCR and were compared between the two groups.Results The positive rate of CEA mRNA in PV was 31.67%after surgery for all patients,higher than before surgery(26.67%),but without statistical difference(P=0.215).The positive rate of CEA mRNA in IMV after tumor dissociation was 51.67%,significantly higher than before tumor dissociation(35.00%).The positive rates of CEA mRNA in preoperative PV,postoperative PV,pre-dissociation IMV,and post-mobilization IMV in the laparoscopic group were 23.33%,30.00%,33.33%,and 50.00%,respectively,while those in the open group were 20.00%,33.33%,36.67%,and 56.67%,with no statistical difference between the two groups.The mean values of CEA mRNA amplification in the laparoscopic group were(4.79±0.85),(3.68±0.26),(3.49±0.09),and(1.06±0.23)at the time points of pre-operation,pre-dissociation,post-dissociation and post-operation,while the values were(5.03±0.75),(3.37±0.14),(3.37±0.30),and(0.86±0.37)in the open group,with no significant difference between the two groups.Conclusions Surgical manipulation may increase the risk of micrometastasis of tumor cells to blood circulation and the principle of"No-Touch"should be strictly observed during the operation.However,there was no significant difference in the effect of these two surgical methods on circulating CEA mRN

关 键 词：结直肠肿瘤 腹腔镜 血液循环 肿瘤 癌胚抗原 

分 类 号：R61[医药卫生—外科学] R730.2[医药卫生—临床医学]