胃癌腹膜微转移的临床研究

Research of peritoneal micrometastasis in patients with gastric carcinoma

目的:研究胃癌患者腹膜微转移的相关因素及临床意义,为临床手术切除范围探寻理论依据。方法:应用CK19和CK20免疫组织化学方法,检测62例胃癌患者横结肠系膜前叶、胰腺被膜、网膜囊后壁和盆底腹膜组织,并与HE染色及腹腔灌洗液细胞学检查对比。结果:62例胃癌患者的腹膜组织常规病理HE染色均未见癌细胞,免疫组织化学证实腹膜微转移阳性率为43.55%(27/62),远高于腹腔灌洗液癌细胞的14.52%(9/62)。胃癌腹膜微转移与肿瘤的大小、浸润深度、临床分期、淋巴结转移有关(P<0.05),而与肿瘤的部位、患者年龄、性别无关(P>0.05)。结论:用免疫组化方法检测胃癌腹膜微转移,可为胃癌根治术术式的选择和术后综合治疗提供可靠依据。对于进展期胃癌患者,应常规腹膜取材检测微转移,多点取材有助于提高微转移检出率。

Objective： To investigate the related factors and clinical significance of peritoneal micrometastasis in patients with gastric carcinoma providing theoretical basis for resection rangeo Methods：CK19,CK20 immunohistochemistry were performed on 62 patients＇ tissues taken from anterior lobe of transverse mesocolon, posterior wall of omental bursa, pancreatic capsule and rectovesical pouch or Douglas pouch during the operations, compared with HE staining and peritoneal lavage cytology（PLC）. Results. No metastasis was found by HE staining. Peritoneal micrometastasis were found in 27 cases out of 62 by immunohistochemistry, and its positive rate was 43.55%, obviously higher than PLC （14.52 %）,The peritoneal micrometastasis of gastric carcinoma had relations with diameter of tumor, depth of infiltration, clinical stage, lymph node metastasis（P〈0.01）, but no relation with the location of gastric carcinoma , age or sex of the patients（P〉0.05）. Conclusion： Immunohistochemistric measure of CK 19 and CK20 can be effective to detect the micrometastasis of gastric carcinoma,which is helpful to guide clinical staging and useful to provide evidence for accurate selection of operation and postoperative treatment.Routine detection of peritoneal micrometastasis should be taken in patients of advanced gastric carcinoma,especially with a large size of serosa invasion.Multiple spots sampling is helpful to improve the detection rate. Anterior lobe of transverse mesocolon and pancreatic capsule should be peeled,and radical resection of omental bursa should be considered as routine operation in these patients.