胃癌术中腹腔冲洗液CK19检测临床意义的探讨

Clinical significance of CK19 in abdominal lavage of patients with gastric cancer

目的探讨胃癌根治术中腹腔冲洗液CK19的检测与胃腺癌分化程度、TNM分期的关系以及腹腔镜胃癌根治术后对肿瘤细胞腹膜微转移的影响。方法应用流式细胞术法检测50例胃癌患者(分开腹组及腹腔镜组)及同期10例胃良性病变患者腹腔冲洗液的CK19表达,比较腹腔镜辅助下胃癌根治术与传统开腹根治术患者腹腔灌洗液的CK19表达,分析腹腔冲洗液CK19的表达与肿瘤组织分化程度、TNM分期的关系。结果胃良性病变患者腹腔冲洗液CK19阳性表达率为0,低分化腺癌组CK19阳性表达率明显高于高中分化腺癌组(P<0.05)。TNM分期Ⅲ期胃癌组腹腔冲洗液CK19阳性表达率显著高于Ⅰ+Ⅱ期患者(P<0.05)。腹腔镜辅助下胃癌根治术患者CK19阳性表达率术后较术前检出率虽有所增加但差异无统计学意义,与开腹组相比较差异亦无统计学意义。结论胃癌患者腹腔冲洗液CK19表达水平与肿瘤分化程度、TNM分期有关,腹腔镜辅助下胃癌根治术与传统开腹手术一样,并不增加腹腔冲洗液的CK19阳性表达率和术后肿瘤腹膜微转移的危险性。

Objective To investigate the effect of CK19 and its clinical significance on the peritoneal micrometastasis in laparoscopic radical gastrectomy. Methods FCM was used to detect the preoperative and post- operative CK19 in the peritoneal lavage fluid in 50 gastric cancer patients treated by different surgical approach （experiment group）, and 10 benign gastric diseases adults were included in the control group. The relationship between peritoneal lavage fluid CK19 and TNM stages as well as tumor differentiation was studied and the CK19 expression of 21 gastric cancer patients treated with laparoscopie radical gastrectomy was compared with that of 29 patients treated by traditional laparotomy. Results The CK19 expression in patients with low differentiation cancers was significantly higher than that in patients with high/moderate differentiation cancers （ P 〈 0.05 ）. The CK19 expression of patients at phase m is significantly higher than that in patients at phase Ⅰ ＋ Ⅱ（ P 〈 0.05 ）. No significant difference was found between preoperative and post-operative positive rate of CK19 in patients treated by laparoscopic radical gastrectomy and no significant difference was found between the laparoscopic and open radical resection of gastric cancer preoperatively or postoperatively. Conclusions Peritoneal lavage fluid CK19 is related to the TNM staging and tumor differentiation. Compared with traditional laparotomy, lapa- roscopic radical gastrectomy of gastric cancer will not increase the positive rate of CK19 in the peritoneal lavage fluid and the risk of micrometastasis of tumor cells.