胃癌患者腹腔冲洗脱落细胞与淋巴结转移的关系

The relationship between peritoneal lavage cytology in gastric carcinoma and lymph node metastasis

目的探讨胃癌患者腹腔冲洗脱落细胞与淋巴结转移的关系。方法回顾性分析2012年6月至2014年5月间在哈尔滨医科大学附属肿瘤医院接受胃癌手术治疗并进行腹腔冲洗脱落细胞学检查的226例胃癌患者的临床病理资料，其中63例腹腔冲洗所用生理盐水量为500ml，163例腹腔冲洗所用生理盐水量为1000ml，分析胃癌患者腹腔冲洗脱落细胞与淋巴结转移的关系。结果63例500ml生理盐水腹腔冲洗组脱落细胞阳性率为11．1％，163例1000ml生理盐水腹腔冲洗组脱落细胞阳性率为9．2％，两组相比差异无统计学意义（χ^2=0．188，P=0．695）。两组胃癌患者腹腔冲洗脱落细胞阳性率与有无淋巴结转移、淋巴结转移数目、淋巴结转移站别、淋巴结总转移率及第二站淋巴结转移率均有关（均P〈0．05），与术中清扫淋巴结数目无关（P〉0．05）。500ml生理盐水腹腔冲洗组的脱落细胞阳性率与第一站淋巴结转移率有关（χ^2=10．787，P=0．001），而1000ml生理盐水腹腔冲洗组的脱落细胞阳性率与第一站淋巴结转移率无关（χ^2=0．994，P=0．319）。结论淋巴结转移是导致胃癌患者腹腔冲洗脱落细胞阳性的一个重要危险因素，尤其是第二站发生转移的淋巴结可能更容易导致脱落细胞的产生。

Objective To explore the relationship between peritoneal lavage cytology in gastric carcinoma and lymph node metastasis. Methods From June 2012 to May 2014, intraoperative peritoneal lavage for cancer cells was carried out in 226 gastric cancer patients undergoing gastrectomy. During the process 63 patients were irrigated with 500 ml of normal saline ,while the others were using 1 000 ml. D2 ＋ lymph nodes dissection was performed to evaluate the relationship between peritoneal lavage cytology in gastric carcinoma and lymph nodes metastasis. Results The positive rates of exfoliative carcinoma ceils were 11.1% in the 500 ml group and 9.2% in the 1 000 ml group （χ^2 =0. 188, P =0.695）. In both groups, rate of exforliative cancer cells were positively related to lymph node metastasis, the numbers of positive lymph nodes, the station of lymph nodes metastasis, the rate of the lymph nodes metastasis and that of the second station （ all P 〈 0. 05 ） , but not to the numbers of the lymph node cleaned （ P 〉 0. 05 ） . Conclusions Lymph nodes metastasis was an important risk factor that contribute to exfoliated carcinoma cells in patients with gastric carcinoma, and especially in those with lymph nodes metastasis at the second station.