腹腔镜结直肠癌根治术对血中CD44、ICAM-1和VCAM-1表达影响的研究

Study on CD44,ICAM-1 and VCAM-1 in blood associated with laparoscopic radical resection

目的分析CD44、细胞间黏附分子-1(ICAM-1)和血管细胞黏附分子-1(VCAM-1)与结直肠癌病理分化及肿瘤进展的关系,探讨腹腔镜结直肠癌根治术对细胞黏附分子的影响进而推论其临床意义。方法采用酶联免疫吸附法(ELISA)检测20例健康成人及55例结直肠癌患者术前术后血清中可溶性CD44v6(sCD44v6)、可溶性ICAM-1(sICAM-1)和可溶性VCAM-1(sV-CAM-1)的表达水平,并与同期开腹手术病例进行比较,结合术后病检分析CD44、ICAM-1和VCAM-1与结直肠癌病理分化程度及肿瘤进展的关系,比较腹腔镜手术与传统开腹手术对肿瘤黏附因子的影响。结果结直肠癌患者中sCD44v6、sICAM-1和sV-CAM-1含量均明显高于对照组(P<0.05);病理分化中低分化及其他组中sCD44v6、sICAM-1和sVCAM-1含量虽比高中分化组高,但差异无统计学意义(P>0.05);但淋巴结转移组和TNM分期Ⅲ期组sCD44v6、sICAM-1和sVCAM-1含量均明显高于淋巴结未转移组和Ⅰ期+Ⅱ期组,差异有统计学意义(P<0.05);腹腔镜手术组和开腹手术组手术前后比较,sCD44v6、sICAM-1和sVCAM-1差异均无统计学意义(P>0.05)。结论sCD44v6、sICAM-1和sVCAM-1含量与结直肠癌的分化程度无关,但与TNM分期、有无区域淋巴结转移有关。提示sCD44v6、sICAM-1和sVCAM-1在结直肠癌的发病过程中具有重要作用,并可以作为结直肠癌诊断、判断预后、监测病情变化的指标之一。腹腔镜结直肠癌手术不促进肿瘤细胞黏附分子的表达,不增加结直肠癌细胞转移的趋势。

Objective To explore the effect of laparoscopic radical resection of colorectal cancer on the expression of adhesion molecules and the clinical significance of determining serum sCD44v6, sICAM-1 and sVCAM 1 and their relation with differentiation and progress of colorectal cancer. Methods The levels of sCD44v6,sICAM-1 and sVCAM-1 were tested in 20 healthy adults and 55 patients undergone laparoscopic radical resection of colorectal cancer or open radical resection of colorectal cancer, by using double antibody sandwich enzyme-linked immnunoadsordent assay（ELISA）, and their changes pre-opeintion and post-operation,laparoscopy and laparotomy,were investigated. Results Colorectal cancer showed significantly higher serum levels of sCD44v6,sICAM-1 and sVCAM-1 compared with those in healthy controls （P〈0.05）. But there was no significant difference between low differentiation and higer/mediate differentiation（P〉0.05）. The expression of sCD44v6,sICAM-1 and sVCAM-1 was significantly higher in the patients categorized to phase Ⅲ than phase Ⅰ /Ⅱ according to TNM staging（P〈0.05）. The concentration of sCD44v6, sICAM-1 and sVCAM-1 had no significant difference between the laparoscopic and open radical resection of colorectal cancer either preoperatively or postoperatively（P〉0.05）. Conclusion The expression of sCD44v6, sICAM-1 and sVCAM-1 is not correlated with tissue difierentiation,but closely related to the stage and metastasis of lymph node. So they may serve as a useful marker for colorectal cancer,closely reflect the development and progress,be useful in prognosis prediction, effective assessment and guidance of multipurpose therapy of colorectal cancer. Laparoscopie radical resection of colorectal cancer does not promote the expression of adhesion molecules,which can not increase the metastatic potential of colorectal cancer cells.