腹腔镜检查与RTＰCR在胃癌诊疗中的临床意义.DOCVIP

临床医学论文-腹腔镜检查与RTＰCR在胃癌诊疗中的临床意义 ??????? 作者：张茂修，张光永，汪运山，孙善会，刘杨 　【摘要】目的：探讨进展期胃癌术前腹腔镜检查与RTＰCR检测腹腔灌洗液中游离癌细胞CEAmRNA的表达水平，在胃癌患者术后微转移及预后的临床意义。方法：对52例进展期胃癌患者术前行腹腔镜探查，灭菌生理盐水冲洗腹腔4~５次，收集脱落细胞，进行细胞学检查和RTＰCＲ检测ＣＥＡmRNA表达水平。结果：52例胃癌患者中，细胞形态学检测326％（１７／52）阳性，RTＰＣR检测５５８％（29/52)ＣＥＡmＲＮＡ阳性表达，二者阳性率有显著性差异（P＜005）。结论：诊断性腹腔镜检查、ＲＴＰＣＲ与ＰＬＣ有效结合，可提高腹腔转移复发诊断的灵敏性和特异性，有助于对胃癌分期、淋巴转移和预后的综合判断，对胃癌的辅助治疗提供依据。 　　【关键词】腹腔镜；胃癌；游离癌细胞；ＲＴＰＣＲ???????????????????????????????????????????????????????????????????????????????????? 　　The clinical significance of laparoscopy chol and RTPcr in gastric carcinoma diagnosis and therapy 　　【Abstract】Ｏbjective:To evaluate CEAmRNA expression of peritoneal lavage fluid(PLF)of patients with progressive gastric cancer by laparoscopy and RTPCR before operation, we assess peritoneal metastasis and prognosis after operation Methods:Before operation, we handled 52 patients with progressive gastric cancer by laparoscopy,washing abdominal cavity with 09%NS about 4~5 times,and collected peritoneal free cells detected by cytology and RT-PCRResults:The overall positive rate of cytology was 326%( 17/52),RTPCR positive rate was 558%(29/52);the rate of RTPCR was significantly higher than cytology findings (P 005)Conclusions:The efficient association of diagnostic LC、RTPCR and PLC(peritoneal lavage cytology)can help improving diagnostic specialty and sensitivity of peritoneal metastasis,synthetically analyzing the relation of stage classification、lymphnode metastasis and prognosis,in order to provide information for further adjuvant therapy 　　【Key words】Laparoscopy；Ｇastric carcinoma;Free cancer cells;RTPCR?????????????????????????????????????????????????????????? 　　胃癌在我国的患病率和死亡率均居恶性肿瘤前列，手术是最有效的治疗方法，但半数以上的患者术后复发转移，从而导致手术失败。国内外学者研究发现腹腔游离癌细胞（free cancer cells，FCC）在腹腔内形成肉眼或ＨＥ染色均不能发现的微转移灶是胃癌复发的重要原因。Nakanishi等［１］提出侵及浆膜层的肿瘤细胞易于脱落的原因与肿瘤细胞缺乏CD44和βintergin 粘附分子表达有关，IFCCs在腹腔细胞刺激因子作用下，生物活性增高，侵及腹膜下组织形成微小转移灶，致术后转移扩散。本研究首次运用腹腔镜的微创伤性、ＲＴＰCＲ的特异性和灵敏性检测腹腔灌洗液（peritoneal lavage fluid，PLF）中游离癌细胞及其ＣＥＡmRNA表达水平，明确胃癌腹