应用RTPCR技术评估腹腔冲洗量对于清除肿瘤脱落细胞的影响.docVIP

应用RT-PCR技术评估腹腔冲洗量对于清除肿瘤脱落细胞的影响 Use of RT-PCR to assess the effect of irrigation volume on the efficiency on rectal washout 徐啸，王文友，彭家远 作者单位：315324 浙江省宁波市，慈溪市第三人民医院普外科（徐啸，王文友）；上海交通大学附属上海市第六人民医院普外科（彭家远） 摘要： 目的：应用RT-PCR技术评估腹腔冲洗量对于胃癌D2根治术清除腹腔肿瘤脱落细胞的影响 方法：72例进展期胃癌患者行D2根治手术，按冲洗量分为A、B、C三组。A组冲洗量在1000ml, B组冲洗量在2000ml, C组冲洗量在3000ml。留取冲洗后的腹腔残留液体，RT-PCR法检测冲洗液中CEA mRNA及CK20mRNA的表达水平，同时与细胞学检测的结果做对比 结果：RT-PCR法A、B、C三组患者胃冲洗液肿瘤脱落细胞的阳性检出率分别为29.2%(7/24例)、16.7%(4/24例)和4.2%（1/24例），具有统计学差异（P=0.03）。细胞学的三组的阳性检出率分别为20.8%（5/24例）、8.3%（2/24例）和0.0%（0/24例）。 结论：随着胃冲洗量增加，肿瘤脱落细胞的检出率逐步降低，胃冲洗量至少应在3000ml以上以有效清除脱落癌细胞。RT-PCR具有高灵敏度，是对细胞学检测很好的补充。 关键词：RT-PCR，胃癌，腹腔冲洗 Abstract Aim: Assess the effect of irrigation volume on the efficiency on peritoneal lavage using RT-PCR Methods: 72 cases of advanced gastric cancer were enrolled and intraoperative peritoneal lavage fluids were collected. They were divided into three groups according to the irrigation volume : group A with 1000ml, Group B with 1500ml and Group C with 2000ml. the level of CEA mRNA and CK20 mRNA in the three groups were evaluated by RT-PCR and the results were compared with that of cytological examination. Results: the detective rate of exfoliated cancer cells by RT-PCR in three groups was 29.2%(7/24cases), 16.7%(4/24cases) and 4.2%（1/24 cases）respectively (P=0.03). And the rate by cytological examination was 20.8%（5/24cases）,8.3%（2/24cases）and 0.0%（0/24cases）. Conclusion: detective rate of exfoliated cancer cells decreased with the increase of irrigation volume for peritoneal larvage t. Large Volume no less than 3000ml and repeated washout might be sufficient to eradicate exfoliated cancer cells. With a high sensitivity, RT-PCR is an ideal supplemental method to detect exfoliated cancer cells. Key words: RT-PCRm gastric cancer, peritoneal lavage 1.引言 腹膜转移或复发是进展期胃癌常见的复发转移途径，标准根治术D2手术能够引起腹腔的播散[1]，术后行腹腔冲洗被认为是降低腹膜转移的有效方法，但是目前对于腹腔冲洗的量无定论，关键的因素之一缺乏有效的检测肿瘤脱落细胞的手段，导致对于冲洗的效果难以评价，既往的细胞学检测准确性不高，显微镜下观察容易受到一些白细胞、间皮细胞等干扰，产生误差。既往研究证实采用RT-PCR同时检测胃癌腹腔冲洗液CE