大肠癌术后腹腔化疗期腹腔灌洗液癌胚抗原的临床意义

Clinical Significance of Continuous Determinating CEA in Peritoneal Irrigation Fluid after Resection of Colorectal Cancer

[目的]研究大肠癌根治术后腹腔化疗期腹腔灌洗液中癌胚抗原(CEA)浓度变化的临床意义。[方法]对1995年1月至1999年12月间收治的108例大肠癌根治性手术的病人 ,术后常规行腹腔化疗 ,采用FDM方案 ,腹腔灌洗液按20ml/kg蒸馏水提供 ,每次化疗前测定血清CEA和腹腔灌洗液CEA的浓度。[结果]术后早期局部和腹膜隐匿性复发血清CEA灵敏度为25% ,特异度为87.5%。腹腔灌洗液CEA灵敏度为91.66% ,特异度为95.83%。腹腔灌洗液CEA早期预警值以>9.40ng/ml高度怀疑早期局部和腹膜隐匿性复发 ,且多发于术后第6个月。术后肝脏微转移血清CEA灵敏度为16.67 % ,特异度为78.57% ,腹腔灌洗液CEA灵敏度为80 % ,特异度为97.62% ,腹腔灌洗液CEA早期预警值以>12.46ng/ml高度怀疑为肝脏微转移 ,多发于术后第9个月。[结论]大肠癌术后腹腔灌洗液CEA检测比血清CEA检测早期腹腔内复发和肝转移更敏感。

To evaluate the clinical significance of the solution change of CEA in peritoneal irrigation fluid of colorectal cancer after operation.One hundred and eight cases of colorectal cancer (1995.1～1999.12)after operation applied intraperitoneal chemotherapy with FDM programe.Distilled water(20ml/kg)was used to irrigate abdominal cavity.The solution of CEA in serum and in peritoneal irrigation fluid was separately determinated.In early local recurrence and occult peritoneal dissemination after operation,the sensitivity and speciality of CEA in serum was 25% and 87.5%,the sensitivity and speciality of CEA in peritoneal irrigation fluid was 91.66% and 95.83% respectively.The CEA in peritoneal irrigation fluid exceeding 9.40ng/ml was an early warn volume of early local recurrence or occult peritoneal dissemination,which was usually found 6 months after operation.Of liver metastases after operation,the rensitivity and speciality of CEA in serum was 16.67% and 78.57%,the sensitivity and speciality of CEA in peritoneal irrigation fluid was 80% and 97.62% respectively.CEA in peritoneal irrigation fluid exceeding 12.46mg/ml probably showed liver metastases,which was found 9 months after operation.[Conclusions] The determination of CEA in peritoneal irrigation fluid is more accurate and more sensitive than that in serum for early local recurrence or occult peritoneal dissemination and liver metastases.