腹腔内游离癌细胞与胃癌生物学行为之间的关系

Relationship between intraabdominal free gastric cancer cells and biologic behavior of gastric carcinoma

目的 :探讨胃癌腹腔内游离细胞与胃癌生物学行为之间的关系 ,选择合理的综合治疗。方法 :经手术后诊断胃癌 149例 ,开腹后使癌灶基底部浆膜面不受任何刺激 ,在浆膜面肉眼观察受侵最明显处行涂片或印片 ,2 0 0ml生理盐水冲洗癌灶 ,不断搅拌 ,边冲边吸入瓶 ,离心后分别行HE染色 ,镜检有无癌细胞。结果 :检出游癌细胞阳性 5 6例 ,游离癌细胞检出率为 3 7.6% ( 5 6 149)。游离癌细胞检出率的高低 ,与癌细胞浸润深度、浆膜面受侵面积大小、生长方式、浆膜形态的外科分型、组织学类型、淋巴结转移关系密切。经高温灌洗、双路温热化疗 3年生存率 3 7.5 % ,5年生存率为 12 .5 %。结论 :胃癌腹腔内游离癌细胞阳性率高低 ,与其生物学行为有着密切关系。必须对腹腔内游离胃癌细胞进行灭活处理 ,腹腔内高温 ( 44℃ - 45℃ )浸泡灌洗 ,早期腹腔内温热 ( 3 8℃ )化疗 ,是提高术后

Objective:To explore the correlation between intraabdominal free cancer cells and the biologic behavior of gastric carcinoma.Methods:One hundred and forty nine cases of gastric cancer proved by both surgery and pathology were studied.Don't stimulate the serosa of primary lesions after opening abdomen.Smear examinations was practised at the serosa where invasion was ogvious,two hundreds millilitre physiological saline irrigated the lesions,mixed constantly and drawn in bottle,then HE colloration and smear examinations were carried out to find cancer cells.Results:Free cancer cells were found in fifty-six cases.Detection rate of isolated cells was 37.6%(56/149),related with the range of serosa invasion,depths of inflitration,growth pathern,morphologic variation,histological variation and lymphogenous metastasis.After higher heating perfusion and double-route heating perfusion chemotherapy,three year survival rate was 37.5%,five year survival rate was 12.5%.Conclusion:The expression of intraabdominal free gastric cancer cells is related to the biologic behavior.So those free cancer cell positive patients must be handled with cancer inactivation,higher heating(44℃～45℃)perfusion and earlier heating perfusion chemotherapy intraabdominally,which is the key of increasing postoperative survival rate.