腹腔镜胃癌手术对腹腔冲洗液中可溶性ICAM-1、CD44v6表达的影响及其意义

Effects and significance of laparoscopically assisted radical gastrectomy on expression of soluble ICAM-1 and CD44v6 in peritoneal lavage

目的研究腹腔镜胃癌手术中腹腔冲洗液中可溶性细胞间黏附分子1(sICAM-1)和可溶性CD44v6(sCD44v6)浓度的变化,探讨腹腔镜胃癌手术对胃癌腹膜种植转移的可能影响。方法将46例胃癌患者分为腹腔镜组26例及开腹组20例,均按13版日本胃癌处理规约行胃癌根治术,术前及术后分别采集腹腔冲洗液。采用酶联免疫吸附法(ELISA)检测腹腔冲洗液中sICAM-1、sCD44v6的浓度水平。结果术前腹腔镜组和开腹组中低分化胃癌腹腔冲洗液中sICAM-1的浓度较高中分化胃癌高,两者差异有统计学意义(P<0.05),而sCD44v6的浓度与分化程度无关;两组胃癌患者腹腔冲洗液中sICAM-1、sCD44v6浓度均与TNM分期密切相关(P<0.05)。两组胃癌患者术后腹腔冲洗液sICAM-1、sCD44v6的表达较术前均显著升高(P<0.05),但腹腔冲洗液中两种黏附分子浓度的变化两组间比较无明显差异(P>0.05)。结论与开腹手术相比,腹腔镜胃癌手术没有增强腹腔冲洗液中sICAM-1、sCD44v6的表达。腹腔镜胃癌手术可能并未通过改变腹腔黏附分子的表达而促进胃癌的腹膜转移。

Objective By observing the changes in expression of soluble intercellular adhesion molecule-1(sICAM-1) and soluble CD44v6(sCD44v6) in peritoneal lavage fluid in laparoscopic and open surgery,to investigate the possible effects of laparoscopically assisted radical gastrectomy on peritoneal metastasis.Methods In accordance with the Japanese Gastric Cancer Treatment Guidelines(13th edition),radical gastrectomy was performed in 26 patients with gastric cancer by laparoscopic surgery and 20 patients by open laparotomy.Peritoneal lavage fluid was collected at the beginning and the end of operation.The concentrations of both sICAM-1 and sCD44v6 were detected by enzyme linked immunosorbent assay(ELISA).Results Before the operation,the sICAM-1 levels were higher in those patients with poorly differentiated gastric cancer compared with that in those patients with well or moderately differentiated tumors(P<0.05).However,the sCD44v6 levels showed no relation to the degree of differentiation.The concentrations of sICAM-1 and sCD44v6 in peritoneal lavage at the beginning of operation were closely correlated to tumor node metastasis(TNM) staging(P<0.05).The levels of both sICAM-1 and sCD44v6 in peritoneal lavage increased obviously as the operation time went on in both groups of patients(P<0.05),and no difference was found in the changes in sICAM-1 and sCD44v6 levels between the two groups(P>0.05).Conclusions Compared with open surgery,laparoscopically assisted radical gastrectomy does not increase the expression of sICAM-1 and sCD44v6 in peritoneal lavage,therefore it seems unlikely that laparoscopic gastrectomy may facilitate the peritoneal metastasis by enhancing the expression of adhesion molecules.