胃癌术中盆腹膜取材检测微转移及其临床意义评估

Detection of Pelvic Peritoneal Micrometastasis and Its Clinical Significance in Gastric Cancer

目的采用胃癌术中直肠子宫(膀胱)陷窝腹膜活检并应用CEA、CK-20免疫组织化学染色的方法确定胃癌腹膜远处的微转移。方法2004年6月至2006年3月期间,选择南京市鼓楼医院40例术前物理学检查和影像学检查未能发现,术中无肉眼及用手可触及的腹膜远处转移的胃癌病例,行术中直肠子宫(膀胱)陷窝腹膜活检并行HE常规染色和CEA、CK-20免疫组织化学染色检查有无腹膜远处微转移。结果本组40例胃癌患者中有10例发生直肠子宫(膀胱)陷窝腹膜的微转移,均发生在肿瘤侵及胃壁全层或浆膜外者〔27.8%(10/36)〕,其微转移发生率明显高于肿瘤未侵及胃壁全层或浆膜外者〔0(0/4)〕,P<0.05。10例中8例淋巴结转移数目均超过6枚,另外2例淋巴结转移数目均为1枚;转移淋巴结数≥7枚时的腹膜微转移发生率〔44.4%(8/18)〕明显高于转移淋巴结数<7枚者〔16.7%(2/12)〕,P<0.05。10例中,有8例为低分化腺癌,2例为中分化腺癌。结论侵及浆膜或浆膜外的胃癌病例,即使在术前检查或术中探查时未发现远处腹膜转移,术中仍可行直肠子宫(膀胱)陷窝腹膜活检,以发现有无远处腹膜的微转移,为胃癌分期、腹腔内辅助化疗及预测预后提供证据。

Objective To find and evaluate the existence of distant peritoneal micrometastasis of gastric cancer in rectovesical pouch or Douglas pouch by using immunohistochemistry method. Methods Forty eases of gastric cancer were collected from June 2004 to March 2006 in Nanjing Gulou hospital. None of them showed obvious dis- tant peritoneal metastasis in preoperative physical and imaging examinations and laparotomy inspection or palpation. Tissues were taken from rectovesical pouch or Douglas pouch during the operations, and HE and CEA/CK-20 immunohistochernistry staining were then performed on the tissues. Results Distant peritoneal micrometastasis in rectovesical pouch or Douglas pouch were found in 10 cases out of the 40 cases, all of which were found to have fullthickness invasion or invasion outside gastric serous tunic [27.8% （10/36）3. Their occurrence rates of peritoneal micrornetastasis were significantly higher than those without full-thickness invasion [0 （0/4）3, P〈0. 05. The number of metastatic lymph nodes was more than six in 8 cases, was only one in 2 case, the occurrence rate of peritoneal micrornetastasis of the number of metastatic lymph nodes was more than seven [44.4% （8/18）3 which was significantly higher than that the number was less than seven [16.7% （2/12）], P〈0. 05. In 10 cases, 8 cases were poorly differentiated adenocarcinoma, and the other two were moderately differentiated. Conclusion When gastric carcinoma invaded serous tunic or outside, though peritoneal metastasis may not be found by preoperational inspection or intraoperative palpation, peritoneal biopsy in reetovesieal pouch or Douglas pouch may be necessary to perform as a routine procedure to detect distant peritoneal micrometastasis. It may be useful for staging, adjuvant chemotherapy and prognosis forecast.