全阻断胃窦癌根治术阻断效果研究

The blocking effect research of complete block technique applied in radical gastrectomy for gastric antrum cancer

目的评估全阻断胃窦癌根治术减少术中癌细胞转移的效果。方法选取复旦大学附属华山医院76例2008年7月至2010年9月收治的胃窦癌病人,随机分为两组,分别施行全阻断胃窦癌根治术(阻断组)和传统胃癌根治术(常规组),进腹后及术中分别抽取门静脉血和腹腔灌洗液,RT-PCR测定样本中CEAmRNA和CK20mRNA的表达情况;阻断组胃壁注射纳米炭后观察阻断区内外淋巴结有无黑染。结果进腹后,阻断组门静脉血CEAmRNA和CK20mRNA阳性率分别为10%(4/40)和15%(6/40),常规组为8.3%(3/36)和11.1%(4/36),两组差异无统计学意义(P>0.05);术中牵拉胃癌病灶时,阻断组门静脉血CEAmRNA和CK20mRNA的阳性率分别为7.5%(3/40)和15%(6/40),常规组为30.5%(11/36)和36%(13/36),两组差异具有统计学意义(P<0.05);腹腔灌洗液CEAmRNA和CK20mRNA的表达率差异无统计学意义。阻断区内淋巴结明显黑染,而阻断区外无淋巴结黑染。结论全阻断胃窦癌根治术可以有效地阻断术中癌细胞血行和淋巴转移。

Objective To study the effect of complete block technique for gastric antrum cancer on preventing intraoperative metastases of tumor cells. Methods Seventy-six cases of gastric antrum cancer admitted between July 2008 and September 2010 at Huashan Hospital of Fudan University were selected in the study. All the cases were randomly divided into two groups and performed radical gastrectomy with complete block technique （blocking group） and traditional radical gastrectomy （conventional group） respectively. Blood samples from the portal vein and peritoneal wash samples were obtained immediately after laparotomy and during surgical resection. RT-PCR was used to determine levels of carcinoembryonic antigen （CEA） and cytokeratin 20 （CK20）. Carbon nanoparticles were injected into the subserosa of the blocked region before resection to determine lymph flow out of the region or not in blocking group. Results Before tumor resection,the positive rate of CEAmRNA and CK20 mRNA expression in portal vein blood was 10%（4/40）and 15%（6/40）in blocking group respectively and 8.3%（3/36）and 11.1% （4/36） in conventional group respectively. There was no significant difference between two groups （P〉0.05）. During tumor resection,the positive rate of CEA mRNA and CK20 mRNA expression in portal vein blood was 7.5%（3/10）and 15.0%（6/40）in blocking group respectively and 30.5% （11/36） and 36.0%（13/36）in conventional group respectively. There was significant difference between two groups （P〈0.05）. The difference was not statistically significant for peritoneal washes. Lymph nodes in the blocked area were fully black dyed while those out of the blocked region were normal. Conclusion Complete block technique can effectively prevent free tumor cells being shed into blood and lymph circulation caused by surgical mobilization to reduce intraoperative metastases.