胃癌术中脱落癌细胞对手术用物的污染情况研究

Contamination of surgical materials by exfoliated cancer cells during gastric carcinoma operation

目的探讨胃癌术中脱落癌细胞对手术用物的污染情况。方法前瞻性入组2011年4月至2012年2月间在浙江省人民医院胃肠外科行根治性手术的90例胃癌患者。术中在肿瘤标本离体时，收集5类手术用物的脱落癌细胞：A类（手术器械），B类（术者手套），C类（洗手护士擦器械及回收残线的纱条及手套），D类（术中压迫止血及清洁术野的纱条、纱垫），E类（缝合器）。对这5类手术用物分别进行细胞培养，培养出癌细胞则为阳性用物。结果31例（34．4％）患者手术用物培养出具有完整细胞膜、细胞质和细胞核的癌细胞。其中上述5类手术用物癌细胞检出率分别为12．2％（11／90）、6．7％（6／90）、22．2％（20／90）、15．6％（14／90）和3．3％（3／90），差异有统计学意义（P=0．001）。Ⅰ、Ⅱ和Ⅲ期患者癌细胞检出率分别为10．0％（1／10）、26．5％（9／34）和45．7％（21／46），差异有统计学意义（P=0．046）。高、中和低分化患者癌细胞检出率分别为1／8、16．7％（4／24）和44．8％（26／58），差异有统计学意义（P=0．020）。结论胃癌根治术中，手术用物易为脱落癌细胞所污染，且随着肿瘤进展、细胞分化程度降低以及手术用物本身使用频率增高和接触范围增加，手术用物被污染的机会越大。

Objective To explore the exfoliated cancer cell contamination in different surgical materials during the malignant gastrectomy. Methods Ninety gastric cancer patients undergoing gastrectomy were prospectively enrolled in this study. The operation materials of these 90 gastrectomy were divided into 5 groups： surgical instruments （A）, gloves for surgeons （B）, gloves and gauzes of scrub nurse （C）, gauzes for hemostasis （D）, anastomosis instrument （E）. The rinse fluid of materials was cultured to verify positive cancer cells. Associations among different pathological stages, differentiations, materials and positive cancer cells rates were examined. Results Stage Ⅱ and Ⅲ patients had higher positive rates of exfoliated cancer cell contamination than stage Ⅰ patients [ 26.5 （9/34） and 47.5% （21/46） vs. 10.0% （1/10）,P=0.046]. Low differentiated adenocarcinoma group had higher positive rate than moderately and well differentiated adenocarcinoma groups [ 44.8% （26/58） vs. 16.7% （4/24） and 12.5% （1/8） ,P=0.020]. Positive cancer cell rates of 5 kinds of materials were as follows： 12.2%（11/90） in A group, 6.7%（6/90） in B group, 22.2%（20/90） in C group, 15.6%（14/90） in D group and 3.3% （3/90） in E group, and the differences were significant （P〈0.01）. Conclusion Different operation materials have different risks to be contaminated by cancer ceils, which is associated with the contact frequency, cancer staging and pathological classification.