不同胸腔灌洗液对肺癌脱落细胞的影响及意义

Effect of Different Pleural Cavity Irrigation Fluid on the Exfoliative Cells of Lung Carcinoma

【目的】研究术中不同胸腔灌洗液对肺癌脱落细胞的影响及意义。【方法】选择无恶性胸腔积液和胸膜未受侵犯的80例肺癌患者,随机分为四组,开胸后用温热生理盐水灌洗胸腔及术毕胸膜腔分别用生理盐水、蒸馏水、顺铂+蒸馏水、顺铂+蒸馏水冲洗,通过透视电子显微镜观察胸腔灌洗液中肺癌脱落细胞的差异,术后患者随访。【结果】顺铂+蒸馏水组灌洗液中完整脱落癌细胞较其他组少,而细胞碎片、凋亡细胞较其他组多不同的胸腔灌洗对胸腔引流量、拔管时间、住院时间没有明显影响,顺铂和(或加)蒸馏水组一年局部复率较对照组明显偏低。【结论】顺铂或(和)蒸馏水对肺癌根治术后胸腔进行灌洗,可减少肺癌脱落细胞在胸腔再种植,提高手术效果。

To study the effect of different pleural cavity irrigation fluid on exfoliative cells of lung carcinoma during operation. [Methods] 80 patients with lung cancer who have no pleural effusion and pleural invasion were randomly divided into four groups. After opening thorax, we irrigated pleural cavity with tepid normal saline, and before closing chest, we irrigated pleural cavity with normal saline, distilled water, cisplatin and normal saline, cisplatin and distilled water respectively, then exfoliative cells of lung carcinoma in the irrigation fluid were observed by electron microscopes. [Results] There were less complete carcinoma cells and more cell debris and apoptotic cells in cisplatin and distilled water group than those in other groups. Differ- ent methods of pleural irrigation had not obvious influence on chest drainage volume, duration of drawing tube and hospital days. Local recurrence rate in cisplatin and/or distilled water group was less than that in control group after one year. [Conclusion] Cisplatin and/or distilled water as post-operative irrigation fluid can influence the re-implantation of exfoliative cells of lung carcinoma in pleural cavity ,and enhance operative effect.