66例胃癌腹腔冲洗细胞学的临床研究  

Peritoneal lavage cytology in 66 patients with gastric carcinoma

作　　者：郑朝旭[1] 袁兴华[1] 荣维淇[1] 孙跃民[1] 崔修铮[1] 赵平[1] 

机构地区：[1]中国医学科学院中国协和医科大学肿瘤研究所肿瘤医院腹部外科,北京100021

出　　处：《中华肿瘤杂志》2003年第2期175-177,共3页Chinese Journal of Oncology

摘　　要：目的　探讨腹腔游离癌细胞形成的相关因素及其与胃癌预后的关系。方法　对 6 6例胃癌患者进行术中腹腔冲洗液细胞学检测 ,分析其与浆膜受侵、淋巴结转移、分期等因素的相关性 ,并通过累积复发曲线分析预后。结果　 6 6例胃癌腹腔冲洗液细胞学阳性率为 36 .4 % (2 4 / 6 6 ) ,浆膜侵犯及淋巴结转移阳性组中 ,腹腔游离癌细胞检出率明显高于阴性组 (P <0 .0 2 5 )。相关因素分析显示 ,浆膜受侵、淋巴结转移及分期 ,与腹腔冲洗细胞学阳性显著相关 ;累积复发分析显示 ,腹腔游离癌细胞阳性者术后腹腔复发较阴性者显著增高 (P <0 .0 1) ,提示预后不佳。结论　腹腔脱落癌细胞形成微转移灶 ,是胃癌术后腹腔复发转移及降低预后的主要危险因素之一 ,浆膜侵犯及腹腔淋巴结转移与腹腔脱落癌细胞呈正相关。术中检测腹腔游离癌细胞有助于评价手术效果、判断预后以及为辅助治疗提供依据。Objective To evaluate the clinical and prognostic value of peritoneal lavage cytology(PLC)in detecting free cancer cells (FCC). Methods PLC of 66 gastric cancer patients being operated was prospectively analyzed to assess the prognostic significance of positive cytological finding and its relation with serosal invasion, lymphnode metastasis and stage classification. Results The overall positive rate of cytology was 36.4% (24/66). These was a closely relation between positive cytology results and serosal invasion( P =0.025), abdominal lymphnode involvement( P <0.005)and stage classification. Peritoneal recurrence in patients with positive cytological findings was significantly higher than that with negative results( P =0.006 7). Conclusion Micrometastasis to the abdominal cavity, formed by free cancer cells exfoliated from the tumor, are significantly responsible for peritoneal dissemination. Serosal invasion and metastatic nodes have greater risk for positive cytology and implies poor prognosis. Peritoneal lavage cytology, if practiced in all gastric cancer patients being operated, can predict the operative effect and prognosis, increase the accuracy of clinical stage and provide information for further adjuvant therapy.

关 键 词：胃癌 腹腔游离癌细胞 细胞学检测 微转移灶 浆膜侵犯 腹腔淋巴结转移 预后 

分 类 号：R735.2[医药卫生—肿瘤]