胃癌网膜囊组织胰蛋白酶细胞消化冲洗研究 - 第三军医大学学报.doc

201402007 两种方法对冲洗胃癌腹腔网膜囊囊壁组织的对比分析 庞再林1，白 鍊1，温泽霖1，赵 鹏1，李启刚1，简 斌1，李中福1，杨 强1，吴 帅1，谢 建1，廖 娟2，钟正福3 （402160 重庆医科大学附属永川医院：普外科1，中心实验室 [摘要] 目的 探索提高胃癌腹腔网膜囊亚临床转移诊断的新方式。方法 选取我院2012年1月至2013年10月胃癌手术患者58例，采取简单随机分组为A、B两组。A组35例应用0.25%胰蛋白酶细胞消化液消化、冲洗胃网膜囊囊壁组织，B组23例采取生理盐水冲洗网膜囊囊壁组织。采取免疫组织化学法与HE染色法检测58例胃癌患者网膜囊冲洗液中癌细胞及CEA、CK7、CK20和HPA的表达。结果 A组患者HE染色阳性16例，阳性率45.71%，免疫组化染色阳性29例，阳性率82.86%。B组患者HE染色阳性4例，阳性率17.39%。免疫组化染色阳性11例，阳性率47.83%。两组数据间差异具有统计学意义(P=0.005)。胰蛋白酶消化冲洗液肿瘤标志物相关分析中，CEA阳性表达与HPA阳性表达呈正相关(r=0.488,P=0.003)，CEA阳性表达与CK7阳性表达呈正(r=0.389, P =0.021)，CEA阳性表达与CK20阳性表达无相关(r=0.299, P =0.081)，CK7、CK20及HPA三者阳性表达呈正相关(P＜0.05)。结论 胰蛋白酶细胞消化液网膜囊冲洗可提高胃癌腹腔亚临床转移的诊断，免疫组化联合检测CEA、CK7、CK20及HPA，较单个肿瘤标志物检测胃癌腹腔网膜囊亚临床转移敏感性高，为判断预后和术后个体化治疗提供依据。 [关键词] 胃癌；网膜囊转移；胰蛋白酶细胞消化液；免疫组织化学染色 [中图法分类号] [文献标志码] A Comparison and analysis of trypsin solution and normal saline washing methods of omental bursa in gastric carcinoma for metastasis diagnosis Pang Zailin1, Bai Lian1, Wen Zelin1, Zhao Peng1, Li Qigang1, Jian Bin1, Li Zhongfu1, Yang Qiang1, Wu Shuai1, Xie Jian1, Liao Juan2, Zhong Zhengfu3 (Department of General Surgery1, Department of Central Laboratory2, Department of Pathology3, Affiliated Yongchuan Hospital of Chongqing Medical University, Chongqing 402160, China) [Abstract] Objective To compare the trypsin solution and normal saline washing methods of omental bursa in gastric carcinoma for metastasis diagnosis. Methods We selected 58 patients with gastric carcinoma in our hospital from January 2012 to October 2013. The patients were randomly divided into two groups, group A (35 patients) with omental bursa digestion and washing by 0.25% trypsin-EDTA solution and group B (23 patients) with omental bursa washing by normal saline. The expression of carcinoembryonic antigen (CEA), cytokeratin 7 (CK7), cytokeratin 20 (CK20) and heparanase (HPA) in the washing precipitation from the 58 patients was tested by immunohistochemical assay and hematoxylin-eosin (HE) staining. Re