胃癌患者腹腔游离癌细胞的监测与腹腔灌注化疗

Clinical Study of Detectable Rate of Intra-Abdominal Free Cancer Cells and Hyperthermic Peritoneal Perfusion Chemotherapy of Patients with Gastric Cancer

目的 探讨腹腔游离癌细胞的测定对术后温热灌注化疗的意义。方法 对我院 10 2例胃癌患者在术中于探查前、关腹前和灌洗化疗后的腹腔液作游离癌细胞检查。结果 探查前游离癌细胞检出率为 3 6.3 % (3 7/ 10 2 ) ,关腹前游离癌细胞检出率为 5 2 .9% (5 4/ 10 2 ) ,腹腔热灌注化疗后有 3 1例找到变性坏死的游离癌细胞 ,其有效率达 5 7.4%(3 1/ 5 4) ;游离癌细胞检出阳性率与肿瘤浸润深度、浆膜受侵面积及病理组织学类型有关。结论 胃癌患者腹腔内有游离癌细胞存在 ,且具有较高活性。手术过程中的创伤刺激可增加癌细胞的脱落 ,因此术中采取无瘤技术和大量生理盐水冲洗腹腔是必要的。腹腔热灌注化疗可有效杀伤癌细胞 。

Objective To evaluate the rational of peritoneal warm perfusion chemotherapy after the operation. Methods One hundred and two patients with gastric cancer were included in this study. One hundred milliliter of peritoneal fluid were collected respectively after opening the abdomen,before closing the peritoneal cavity,and after hyperthermic peritoneal perfusion chemotherapy for free cancer cells examination. Results After opening the abdomen, the positive rate of free cancer cells was 36.3%(37/102), and the positive rate before closure of peritoneal cavity was 52.9%(54/102), 31 cases of free cancer cells were found killed after the warm perfusion chemotherapy,the effect rate was 57.4 %(31/54).The free cancer cells positive rate related to the tumor infiltration depth, serous membrane invasion area and the type of histopathology. Conclusion In the peritoneal cavity of patients with gastric cancer, free cancer cells are able to survive and have a high degree of activity. Hyperthermic peritoneal perfusion chemotherapy is an effective method to kill free cancer cells.