摘要
目的探讨提高胃癌腹腔网膜囊亚临床转移诊断率的新方式。方法选取我科2012年1月至2013年10月胃癌手术患者58例,随机分为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。采用免疫组织化学法与HE染色法检测、对比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<0.01)。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<0.01),CEA阳性表达与CK7阳性表达呈正相关(r=0.389,P<0.05),CEA阳性表达与CK20阳性表达无相关(r=0.299,P>0.05),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率,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。
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 2 groups,group A（n =35） with omental bursa digestion and washing by 0.25% trypsin-EDTA solution and group B（n =23）with omental bursa washing by normal saline.The expression of carcinoembryonic antigen（CEA）,cytokeratin7（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.Results In group A,16 cases showed positive results in HE staining,with positive rate 45.71%,and 29 cases showed positive results in immunohistochemical assay,with positive rate 82.86%.In group B,4 cases showed positive results in HE staining,with positive rate 17.39%,and 11 cases showed positive results in immunohistochemical assay,with positive rate 47.83%.The difference was statistically significant（P = 0.005）.In the correlation analysis of tumor markers by the trypsin solution washing method,CEA was positively correlated with HPA（r = 0.488,P 0.01） as well as CK7（r = 0.389,P 0.05）,but not correlated with CK20（r = 0.299,P 0.05）.There were significant correlation among positive expression of CK7,CK20 and HPA（P 0.05）.Conclusion Omental bursa digestion and washing by trypsin-EDTA solution improves the diagnosis of peritoneal subclinical metastasis of gastric cancer.As compared to a single tumor marker,combined detection of CEA,CK7,CK20 and HPA by immunohistochemical assay increases the diagnosis sensitivity of subclinical metastasis,providing a theoretical basis for individualized treatment and prognosis.
出处
《第三军医大学学报》
CAS
CSCD
北大核心
2014年第14期1515-1518,共4页
Journal of Third Military Medical University
基金
重庆市永川区科委项目(YCSTC2012BE5003)~~
