CAJ | 학술논문

目的探讨原发性肝细胞癌术中手术用物携带脱落癌细胞的情况.方法 78例原发性肝细胞癌术中用物分四组:A.手术器械；B.术者手套；C.器械护士手套及擦器械、回收残线的纱条；D.清洁术野的纱条、纱垫.术中用物生理盐水浸泡、低速离心后,沉淀物瑞氏染色观察,携带癌细胞者为阳性用物.结果手术用物癌细胞阳性检出率与TNM分期、肿瘤位置、肿瘤大小以及手术方式显著相关.TNM分期Ⅲ期肝癌手术用物癌细胞阳性检出率较Ⅰ、Ⅱ期用物高(56.3％比21.7％,P=0.002)；肿瘤位置、大小与手术用物癌细胞阳性检出率显著相关(P=0.003,P=0.001)；不规则性肝切除癌细胞检出率显著高于规则性切除(53.8％比26.9％,P=0.019).而且不同的手术用物间癌细胞阳性检出率有显著差异(P=0.008),C组用物癌细胞检出率最高.结论术中用物癌细胞污染程度与肝细胞癌分期进展、肿瘤位置、大小以及手术方式明显相关,且随用物使用频率、接触范围增加而增加,与用物性质密切相关.
목적 탐토원발성간세포암술중수술용물휴대탈락암세포적정황.방법 78례원발성간세포암술중용물분사조:A.수술기계；B.술자수투；C.기계호사수투급찰기계、회수잔선적사조；D.청길술야적사조、사점.술중용물생리염수침포、저속리심후,침정물서씨염색관찰,휴대암세포자위양성용물.결과 수술용물암세포양성검출솔여TNM분기、종류위치、종류대소이급수술방식현저상관.TNM분기Ⅲ기간암수술용물암세포양성검출솔교Ⅰ、Ⅱ기용물고(56.3％비21.7％,P=0.002)；종류위치、대소여수술용물암세포양성검출솔현저상관(P=0.003,P=0.001)；불규칙성간절제암세포검출솔현저고우규칙성절제(53.8％비26.9％,P=0.019).이차불동적수술용물간암세포양성검출솔유현저차이(P=0.008),C조용물암세포검출솔최고.결론 술중용물암세포오염정도여간세포암분기진전、종류위치、대소이급수술방식명현상관,차수용물사용빈솔、접촉범위증가이증가,여용물성질밀절상관.
Objective To investigate the risks of operative contamination of surgical gear by exfoliated cancer in 78 patients who received surgery for hepatocellular carcinoma.Methods Surgical gear from 78 patients who were operated for primary hepatocellular carcinoma were divided into four groups:A.surgical instruments; B.surgeon gloves; C.gauze and gloves used for cleaning equipment; D.gauze and gauze pad used for cleaning operation area.Saline was used to soak the surgical gear followed by low speed centrifugation.The precipitate was stained and then observed for cancer cells.Results The positive rates of cancer cell on surgical gear were significantly associated with the TNM stage,tumor location,tumor size,and surgical approach.The positive rate of liver cancer cell on surgical gear in TNM stage Ⅲ was higher than TNM stage Ⅰ / Ⅱ (56.3％ vs 21.7％,P=0.002).The positive rate of cancer cell on surgical gear was significantly related to tumor size and location (P=0.006,P=0.001).The positive cancer cell detection rate of non-anatomical liver resection was significantly higher than anatomical resection (53.8 ％ vs 26.9 ％,P =0.019).The positive cancer cell detection rate was significantly associated with different types of surgical gear (P=0.008),in which group C showed the highest cancer cell detection rate.Conclusion The risks of cancer cell contamination of surgical gear were significantly associated with progression of hepatocellular carcinoma,tumor size,location and surgical approach,and also associated with the frequency in the use of surgical gear,the operation scope of contact and the nature of surgical gear.