目的 采用胃癌術(shù)中直腸子宮(膀胱)陷窩腹膜活檢并應(yīng)用CEA、CK-20免疫組織化學(xué)染色的方法確定胃癌腹膜遠(yuǎn)處的微轉(zhuǎn)移.方法 2004年6月至2006年3月期間,選擇南京市鼓樓醫(yī)院40例術(shù)前物理學(xué)檢查和影像學(xué)檢查未能發(fā)現(xiàn),術(shù)中無肉眼及用手可觸及的腹膜遠(yuǎn)處轉(zhuǎn)移的胃癌病例,行術(shù)中直腸子宮(膀胱)陷窩腹膜活檢并行HE常規(guī)染色和CEA、CK-20免疫組織化學(xué)染色檢查有無腹膜遠(yuǎn)處微轉(zhuǎn)移.結(jié)果 本組40例胃癌患者中有10例發(fā)生直腸子宮(膀胱)陷窩腹膜的微轉(zhuǎn)移, 均發(fā)生在腫瘤侵及胃壁全層或漿膜外者[27.8%(10/36)],其微轉(zhuǎn)移發(fā)生率明顯高于腫瘤未侵及胃壁全層或漿膜外者[0(0/4)],P＜0.05.10例中8例淋巴結(jié)轉(zhuǎn)移數(shù)目均超過6枚,另外2例淋巴結(jié)轉(zhuǎn)移數(shù)目均為1枚; 轉(zhuǎn)移淋巴結(jié)數(shù)≥7枚時(shí)的腹膜微轉(zhuǎn)移發(fā)生率 [44.4%(8/18)]明顯高于轉(zhuǎn)移淋巴結(jié)數(shù)＜7枚者[16.7%(2/12)],P＜0.05.10例中,有8例為低分化腺癌,2例為中分化腺癌.結(jié)論 侵及漿膜或漿膜外的胃癌病例,即使在術(shù)前檢查或術(shù)中探查時(shí)未發(fā)現(xiàn)遠(yuǎn)處腹膜轉(zhuǎn)移,術(shù)中仍可行直腸子宮(膀胱)陷窩腹膜活檢,以發(fā)現(xiàn)有無遠(yuǎn)處腹膜的微轉(zhuǎn)移,為胃癌分期、腹腔內(nèi)輔助化療及預(yù)測(cè)預(yù)后提供證據(jù).
引用本文： 邱文才,王唯剛,王志剛,陳剛,席時(shí)富,鄭起. 胃癌術(shù)中盆腹膜取材檢測(cè)微轉(zhuǎn)移及其臨床意義評(píng)估. 中國(guó)普外基礎(chǔ)與臨床雜志, 2008, 15(1): 2-30. doi: 復(fù)制
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- 1. <>[1]朱正綱.充分重視胃癌腹膜轉(zhuǎn)移的預(yù)防、診斷與治療[J].外科理論與實(shí)踐,2003; 8(1)∶16.
- 2. 王舒寶,王俊.胃癌復(fù)發(fā)與轉(zhuǎn)移的有關(guān)問題及綜合治療[J].中國(guó)普外基礎(chǔ)與臨床雜志,2006; 13(1)∶9.
- 3. Yun HY,Bandou E,Kawamura T,et al.Influence of micrometastasis on N stage in gastric cancer and clinical application[J].J Exp Clin Cancer Res,2005; 24(4)∶531.
- 4. Mori T,Fujiwara Y,Sugita Y,et al.Application of molecular diagnosis for detection of peritoneal micrometastasis and evaluation of preoperative chemotherapy in advanced gastric carcinoma[J].Ann Surg Oncol,2004; 11(1)∶14.
- 5. Morgagni P,Saragoni L,Scarpi E,et al.Lymph node micrometastases in early gastric cancer and their impact on prognosis[J].World J Surg,2003; 27(5)∶558.
- 6. Tsujitani S,Oka S,Suzuki K,et al.Prognostic factors in patients with advanced gastric cancer treated by noncurative resection:a multivariate analysis[J].Hepatogastroenterology,2001; 48(41)∶1504.
- 7. Yoo CH,Noh SH,Shin DW,et al.Recurrence following curative resection for gastric carcinoma[J].Br J Surg,2000; 87(2)∶236.
- 8. Raj GV,Moreno JG,Gomella LG.Utilization of polymerase chain reaction technology in the detection of solid tumors[J].Cancer,1998; 82(8)∶1419.
- 9. Sakakura C,Takemura M,Hagiwara A,et al.Overexpression of dopa decarboxylase in peritoneal dissemination of gastric cancer and its potential as a novel marker for the detection of peritoneal micrometastases with real-time RT-PCR[J].Br J Cancer,2004; 90(3)∶665.
- 10. Kojima N,Kunieda K,Matsui K,et al.Evaluation of carcinoembryonic antigen mRNA in living,necrotic,and apoptotic gastric cancer cells by reverse transcriptase-polymerase chain reaction[J].Surg Today,2003; 33(11)∶839.
- 11. Chen XM,Chen GY,Wang ZR,et al.Detection of micrometastasis of gastric carcinoma in peripheral blood circulation[J].World J Gastroenterol,2004; 10(6)∶804.
- 12. Osaka H,Yashiro M,Sawada T,et al.Is a lymph node detected by the dye-guided method a true sentinel node in gastric cancer?[J].Clin Cancer Res,2004; 10(20)∶6912.
- 13. 達(dá)明緒,趙紫罡,羅婷,等.胃癌細(xì)胞增殖與腹腔灌洗液中端粒酶活性及腹膜轉(zhuǎn)移的相關(guān)性研究[J].中國(guó)普外基礎(chǔ)與臨床雜志,2006; 13(1)∶25.
- 14. Nishida S,Kitamura K,Ichikawa D,et al.Molecular detection of disseminated cancer cells in the peripheral blood of patients with gastric cancer[J].Anticancer Res,2000; 20(3B)∶2155.
- 15. Zhong XY,Kaul S,Lin YS,et al.Sensitive detection of micrometastases in bone marrow from patients with breast cancer using immunomagnetic isolation of tumor cells in combination with reverse transcriptase/polymerase chain reaction for cytokeratin-19[J].J Cancer Res Clin Oncol,2000; 126(4)∶212.
- 16. Nakanishi H,Kodera Y,Yamamura Y,et al.Rapid quantitative detection of carcinoembryonic antigen-expressing free tumor cells in the peritoneal cavity of gastric-cancer patients with real-time RT-PCR on the lightcycler[J].Int J Cancer,2000; 89(5)∶411.
- 17. Yonemura Y,Fujimura T,Ninomiya I,et al.Prediction of peritoneal micrometastasis by peritoneal lavaged cytology and reverse transcriptase-polymerase chain reaction for matrix metalloproteinase-7 mRNA[J].Clin Cancer Res,2001; 7(6)∶1647.
- 18. Suo J,Wang Q,Jin HJ,et al.K-19 mRNA RT-PCR in detecting micrometastasis in regional lymph nodes of gastric cancer[J].World J Gastroenterol,2006; 12(32)∶5219.
- 19. Arigami T,Natsugoe S,Uenosono Y,et al.Evaluation of sentinel node concept in gastric cancer based on lymph node micrometastasis determined by reverse transcription-polymerase chain reaction[J].Ann Surg,2006; 243(3)∶341.
- 20. Kodera Y,Nakanishi H,Ito S,et al.Clinical significance of isolated tumor cells and micrometastases in patients with gastric carcinoma[J].Gan To Kagaku Ryoho,2007; 34(6)∶817.