肺癌术中肺血管结扎顺序对肺癌微转移影响的研究

Influence of order of pulmonary vessel ligation in lung carcinoma radical operation on micrometastasis

目的:探讨肺癌患者术中肺血管结扎顺序对肺癌微转移影响及临床意义。方法:60例非小细胞肺癌手术患者,术前随机分为先扎动脉组和先扎静脉组,每组30例,术前、术中和术后取患者外周静脉血,巢式RT-PCR方法检测外周血中CK19 mRNA、LUNX mR-NA表达。选取10名健康成年人(健康组)外周静脉血做阴性对照。结果:术前先扎动脉组患者外周血中CK19 mR-NA、LUNX mRNA表达率与健康组比较,差异均有统计学意义(P<0.05),术前先扎静脉组患者外周血中CK19 mR-NA、LUNX mRNA表达率与健康组比较,差异均有统计学意义(P<0.05),而先扎动脉组和先扎静脉组间术前比较差异均无统计学意义(χ2=0.000,P=1.000),但术中与术后比较差异均有统计学意义(P<0.05)。CK19 mRNA、LUNX mRNA在术前、术中、术后间差异有统计学意义(P<0.05),而CK19mRNA、LUNX mRNA两者之间差异无统计学意义(P>0.05)。腺癌与鳞癌间差异无统计学意义(P>0.05)。Ⅰ、Ⅱ和Ⅲ期肺癌间差异有统计学意义(P<0.05)。结论:肺癌术中先结扎肺静脉可减少癌细胞的微转移。CK19mRNA、LUNXmRNA可以作为检测肺癌外周血中癌细胞微转移的2个指标,预测肺癌微转移。

OBJECTIVE：To explore the influence of the order of pulmonary vessel ligation in lung carcinoma（LC）radical operation on micrometastasis and its clinic significance.METHODS：Sixty patients with non-small cell lung cancer （NSCLC） were randomly assigned into two groups：the patients in the vein group were first given pulmonary vein ligation（FLVG）,and the patients in the artery group were first given artery（FLAG）.Both accepted radical operation performed by the same team of doctors.Peripheral venous blood （PVB） was collected one day before operation,the day of operation and one week after operation.CK19 mRNA and LUNX mRNA expressions in PVB were detected by nested PCR method to compare with those of the control group（10 healthy adults）.RESULTS：The positive rates of CK19 mRNA and LUNX mRNA expression were higher in FLAG patients than that in control ground （P0.05）,and the positive rates of CK19 mRNA and LUNX mRNA expression were higher in FLVG patients than in control group （P0.05）.But no between CK19 mRNA and LUNX mRNA positive expression rate in FLVG and FLAG at preoperation （χ2=0.000,P=1.000）,and there were statistic meaning in FLVG and FLAG between intraoperation and posroperation （P0.05）.CK19 mRNA,LUNX mRNA among the preoperative,intraoperation and postoperation were statistically significant （P0.05）,but there were no statistical difference of CK19 mRNA,LUNX mRNA between the two index in the preoperation,intraoperative and postoperation group （P0.05）.CK19 mRNA and LUNX mRNA positive expressions rates had no significant differences between squamous cell carcinoma and adenocarcinoma （P0.05）,but had high significant differences among Stage Ⅰ,Stage Ⅱ and Stage Ⅲ （P0.05）.CONCLUSIONS：Radical operations should be performed first by ligating pulmonary veins to reduce LC cells micrometastasis of PVB.CK19 mRNA and LUNX mRNA are favorable 2 indexes for detecting tumor cells micrometastasis in PVB of LC,predicting lung cancer micrometastases.