胃癌胰腺被膜及横结肠系膜前叶转移规律及其临床意义

The investigation of capsul of the pancreas dissection in the laparoscopic radical surgery of distal gastric cancer

目的探讨胃癌胰腺被膜及横结肠系膜前叶转移规律,指导腹腔镜胃癌根治术胰腺被膜及横结肠系膜前叶切除的合理性。方法回顾分析2007年1月至2008年7月收治的83例行胃癌根治术清扫胰腺被膜患者的临床资料,利用免疫组化及聚合酶链式反应(PCR)等方法对各期胃癌胰腺被膜转移进行相关性分析。结果细胞角蛋白20(CK20)、癌胚抗原(CEA)检测阳性率分别为24.1%(20/83)、26.5%(22/83),CK20 mRNA、CEA mRNA阳性率分别为50.6%(42/83)、38.6%(32/83)。胃癌胰腺被膜癌转移与肿瘤的浸润深度、病理分型、临床分期、淋巴结转移有关(P<0.05),而与患者的年龄、性别无关(P>0.05)。结论在胃癌根治术中可以选择性清扫胰腺被膜,为腹腔镜胃癌根治术进行选择性清扫胰腺被膜提供了依据。

Objective Investigate the occurrence of gastric cancer micrometastasis of factors and the law, for the establishment of individualized surgical treatment options to provide more reliable basis. Methods From January 2007 to July 2008 during the open radical gastrectomy and laparoseopic resection of gastric cancer pancreatic capsule cleaning clinical data. The use of tissue pathology, immunohistochemistry and PCR methods to confirm whether laparoseopic radical gastrectomy should be selective removal of the pancreas capsule. Results The regular pathology was negative of all the 83 patients, but CK20 and CEA positive cells were found in the capsul of the pancreas of 20 patients （ 24.1% ） and 22 patients （ 26.5 % ）. CK20 mRNA and CEA mRNA positive cells were found in the capsul of the pancreas of 42 patients （ 50.6 % ） and 32 patients （ 38.6 % ）. Envelope of pancreatic metastasis of gastric cancer with depth of tumor invasion, pathological type, clinical stage, lymph node metastasis （ P 〈 0.05 ）, and with the patients age, sex （ P 〉 0.05 ）. Conclusions Capsul of the pancreas should be selectively dissected in the surgery of distal gastric cancer, which also provides an evidence for such procedure in laparoscopic radical resection of gastric cancer.