目的 探讨不同浆膜受侵犯面积胃癌患者行腹腔镜胃癌根治术对腹腔微转移的影响.方法 回顾性分析2012年10月至2014年10月第三军医大学西南医院收治的114例行腹腔镜胃癌根治术的胃癌患者的临床资料.收集患者腹腔冲洗液和手术切除的胃组织标本进行研究.应用AutoCAD软件计算患者手术切除胃组织标本的浆膜受侵犯面积.浆膜未受侵犯患者32例,设为A组;浆膜受侵犯面积＜5 cm2患者30例,设为B组;浆膜受侵犯面积为5～10 cm2患者27例,设为C组;浆膜受侵犯面积＞ 10 cm2患者25例,设为D组.B、C、D组患者为T4a期胃癌.采用荧光定量RT-PCR法检测腹腔冲洗液中CEA mRNA和多巴脱羧酶(DDC)mRNA相对表达量.采用门诊及电话方式进行随访,随访时间截至2015年4月.计数资料采用x2检验.符合正态分布的计量资料以(x)±s表示,多组间比较采用方差分析,手术前后比较采用重复测量的方差分析.采用Kaplan-Meier法绘制生存曲线,Log-rank检验进行生存分析.结果 A组、B组、C组及D组患者术前腹腔冲洗液中CEA mRNA的相对表达量分别为0.172±0.013、0.194±0.017、0.221 ±0.018、0.256±0.021,术后CEA mRNA的相对表达量分别为0.199±0.012,0.217±0.018、0.245±0.012、0.565 ±0.026;4组患者术前腹腔冲洗液中DDC mRNA的相对表达量分别为0.186±0.011、0.227±0.021、0.244±0.019、0.268±0.025,术后DDC mRNA的相对表达量分别为0.213±0.018、0.257±0.020、0.281±0.024、0.573±0.049.4组患者术前CEA mRNA、术后CEA mRNA、术前DDC mRNA、术后DDCmRNA比较,差异均有统计学意义(F=291.865,397.488,289.541,381.769,P＜0.05).进一步分析:A组、B组、C组术前腹腔冲洗液中CEA mRNA的相对表达量与术后比较,差异均无统计学意义(F=1.651,0.681,1.381,P＞0.05);D组术前腹腔冲洗液中CEA mRNA的相对表达量与术后比较,差异有统计学意义(F=46.228,P＜0.05).A组、B组、C组术前腹腔冲洗液中DDC mRNA的相对表达量与术后比较,差异均无统计学意义(F=1.179,1.309,1.321,P＞0.05);D组术前腹腔冲洗液中DDC mRNA的相对表达量与术后比较,差异有统计学意义(F=7.455,P＜0.05).104例患者获得术后随访,随访率为91.23％(104/114),中位随访时间为15.5个月(3.0～30.0个月).104例获得随访患者中,A组、B组、C组及D组2年累积生存率分别为90.6％、83.3％、77.7％、64.0％.4组患者生存情况比较,差异有统计学意义(x2=14.600,P＜0.05).A组与B组、A组与C组、B组与C组患者生存情况比较,差异均无统计学意义(x2=0.733,1.045,0.034,P＞0.05);D组分别与A组、B组、C组患者生存情况比较,差异均有统计学意义(x2=9.081,4.939,3.957,P＜0.05).结论 胃癌患者浆膜受侵犯面积≤10 cm2时,行腹腔镜胃癌根治术并不增加腹腔微转移几率,手术安全可行.
目的 探討不同漿膜受侵犯麵積胃癌患者行腹腔鏡胃癌根治術對腹腔微轉移的影響.方法 迴顧性分析2012年10月至2014年10月第三軍醫大學西南醫院收治的114例行腹腔鏡胃癌根治術的胃癌患者的臨床資料.收集患者腹腔遲洗液和手術切除的胃組織標本進行研究.應用AutoCAD軟件計算患者手術切除胃組織標本的漿膜受侵犯麵積.漿膜未受侵犯患者32例,設為A組;漿膜受侵犯麵積＜5 cm2患者30例,設為B組;漿膜受侵犯麵積為5～10 cm2患者27例,設為C組;漿膜受侵犯麵積＞ 10 cm2患者25例,設為D組.B、C、D組患者為T4a期胃癌.採用熒光定量RT-PCR法檢測腹腔遲洗液中CEA mRNA和多巴脫羧酶(DDC)mRNA相對錶達量.採用門診及電話方式進行隨訪,隨訪時間截至2015年4月.計數資料採用x2檢驗.符閤正態分佈的計量資料以(x)±s錶示,多組間比較採用方差分析,手術前後比較採用重複測量的方差分析.採用Kaplan-Meier法繪製生存麯線,Log-rank檢驗進行生存分析.結果 A組、B組、C組及D組患者術前腹腔遲洗液中CEA mRNA的相對錶達量分彆為0.172±0.013、0.194±0.017、0.221 ±0.018、0.256±0.021,術後CEA mRNA的相對錶達量分彆為0.199±0.012,0.217±0.018、0.245±0.012、0.565 ±0.026;4組患者術前腹腔遲洗液中DDC mRNA的相對錶達量分彆為0.186±0.011、0.227±0.021、0.244±0.019、0.268±0.025,術後DDC mRNA的相對錶達量分彆為0.213±0.018、0.257±0.020、0.281±0.024、0.573±0.049.4組患者術前CEA mRNA、術後CEA mRNA、術前DDC mRNA、術後DDCmRNA比較,差異均有統計學意義(F=291.865,397.488,289.541,381.769,P＜0.05).進一步分析:A組、B組、C組術前腹腔遲洗液中CEA mRNA的相對錶達量與術後比較,差異均無統計學意義(F=1.651,0.681,1.381,P＞0.05);D組術前腹腔遲洗液中CEA mRNA的相對錶達量與術後比較,差異有統計學意義(F=46.228,P＜0.05).A組、B組、C組術前腹腔遲洗液中DDC mRNA的相對錶達量與術後比較,差異均無統計學意義(F=1.179,1.309,1.321,P＞0.05);D組術前腹腔遲洗液中DDC mRNA的相對錶達量與術後比較,差異有統計學意義(F=7.455,P＜0.05).104例患者穫得術後隨訪,隨訪率為91.23％(104/114),中位隨訪時間為15.5箇月(3.0～30.0箇月).104例穫得隨訪患者中,A組、B組、C組及D組2年纍積生存率分彆為90.6％、83.3％、77.7％、64.0％.4組患者生存情況比較,差異有統計學意義(x2=14.600,P＜0.05).A組與B組、A組與C組、B組與C組患者生存情況比較,差異均無統計學意義(x2=0.733,1.045,0.034,P＞0.05);D組分彆與A組、B組、C組患者生存情況比較,差異均有統計學意義(x2=9.081,4.939,3.957,P＜0.05).結論 胃癌患者漿膜受侵犯麵積≤10 cm2時,行腹腔鏡胃癌根治術併不增加腹腔微轉移幾率,手術安全可行.
목적 탐토불동장막수침범면적위암환자행복강경위암근치술대복강미전이적영향.방법 회고성분석2012년10월지2014년10월제삼군의대학서남의원수치적114례행복강경위암근치술적위암환자적림상자료.수집환자복강충세액화수술절제적위조직표본진행연구.응용AutoCAD연건계산환자수술절제위조직표본적장막수침범면적.장막미수침범환자32례,설위A조;장막수침범면적＜5 cm2환자30례,설위B조;장막수침범면적위5～10 cm2환자27례,설위C조;장막수침범면적＞ 10 cm2환자25례,설위D조.B、C、D조환자위T4a기위암.채용형광정량RT-PCR법검측복강충세액중CEA mRNA화다파탈최매(DDC)mRNA상대표체량.채용문진급전화방식진행수방,수방시간절지2015년4월.계수자료채용x2검험.부합정태분포적계량자료이(x)±s표시,다조간비교채용방차분석,수술전후비교채용중복측량적방차분석.채용Kaplan-Meier법회제생존곡선,Log-rank검험진행생존분석.결과 A조、B조、C조급D조환자술전복강충세액중CEA mRNA적상대표체량분별위0.172±0.013、0.194±0.017、0.221 ±0.018、0.256±0.021,술후CEA mRNA적상대표체량분별위0.199±0.012,0.217±0.018、0.245±0.012、0.565 ±0.026;4조환자술전복강충세액중DDC mRNA적상대표체량분별위0.186±0.011、0.227±0.021、0.244±0.019、0.268±0.025,술후DDC mRNA적상대표체량분별위0.213±0.018、0.257±0.020、0.281±0.024、0.573±0.049.4조환자술전CEA mRNA、술후CEA mRNA、술전DDC mRNA、술후DDCmRNA비교,차이균유통계학의의(F=291.865,397.488,289.541,381.769,P＜0.05).진일보분석:A조、B조、C조술전복강충세액중CEA mRNA적상대표체량여술후비교,차이균무통계학의의(F=1.651,0.681,1.381,P＞0.05);D조술전복강충세액중CEA mRNA적상대표체량여술후비교,차이유통계학의의(F=46.228,P＜0.05).A조、B조、C조술전복강충세액중DDC mRNA적상대표체량여술후비교,차이균무통계학의의(F=1.179,1.309,1.321,P＞0.05);D조술전복강충세액중DDC mRNA적상대표체량여술후비교,차이유통계학의의(F=7.455,P＜0.05).104례환자획득술후수방,수방솔위91.23％(104/114),중위수방시간위15.5개월(3.0～30.0개월).104례획득수방환자중,A조、B조、C조급D조2년루적생존솔분별위90.6％、83.3％、77.7％、64.0％.4조환자생존정황비교,차이유통계학의의(x2=14.600,P＜0.05).A조여B조、A조여C조、B조여C조환자생존정황비교,차이균무통계학의의(x2=0.733,1.045,0.034,P＞0.05);D조분별여A조、B조、C조환자생존정황비교,차이균유통계학의의(x2=9.081,4.939,3.957,P＜0.05).결론 위암환자장막수침범면적≤10 cm2시,행복강경위암근치술병불증가복강미전이궤솔,수술안전가행.
Objective To investigate the effects of laparoscopic radical gastrectomy on the peritoneal micrometastases of gastric cancer in patients with serosal invasion.Methods The clinical data of 114 patients with gastric cancer who underwent laparoscopic radical gastrectomy at the Southwest Hospital between October 2012 and October 2014 were retrospectively analyzed.The peritoneal irrigation fluids and tissue specimens from surgical resection were collected,respectively.The area of serosal invasion in the tissue specimens was calculated by AutoCAD software.There were 32 patients without serosal invasion (A group),30 patients with the area of serosal invasion ＜ 5 cm2 (B group),27 patients with the area of serosal invasion≥5 cm2 and ≤ 10 cm2 (C group) and 25 patients with the area of serosal invasion ＞ 10 cm2 (D group).The patients of the B,C and D groups were confinned in the T4a stage of gastric cancer.The relative expressions of carcinoembryonic antigen (CEA) mRNA and dopa decarboxylase (DDC) mRNA in the peritoneal irrigation fluids were detected by the fluorescent quantitative real-time PCR (RT-PCR).The follow-up by outpatient examination and telephone interview were done up to April 2015.The count data were analyzed by the chi-square.The measurement data with normal distribution were presented as (x) ± s.The comparison among groups was analyzed using the ANOVA.The preoperative and postoperative comparisons were analyzed by the repeated measures ANOVA.The survival curve was drawn by Kaplan-Meier method,and the survival analysis was done using the Log-rank test.Results The relative expressions of CEA mRNA in the preoperative peritoneal irrigation fluids in the A,B,C and D groups were 0.172 ±0.013,0.194 ±0.017,0.221 ± 0.018 and 0.256 ± 0.021,respectively.The relative expressions of CEA mRNA in the postoperative peritoneal irrigation fluids in the A,B,C and D groups were 0.199 ±0.012,0.217 ±0.018,0.245 ±0.012and 0.565 ± 0.026,respectively.The relative expressions of DDC mRNA in the preoperative peritoneal irrigation fluids in the A,B,C and D groups were 0.186 ± 0.011,0.227 ± 0.021,0.244 ± 0.019 and 0.268 ± 0.025,respectively.The relative expressions of DDC mRNA in the postoperative peritoneal irrigation fluids in the A,B,C and D groups were 0.213 ± 0.018,0.257 ± 0.020,0.281 ± 0.024 and 0.573 ± 0.049,respectively.There were significant differences in the above indexes among the 4 groups (F =291.865,397.488,289.541,381.769,P ＜ 0.05).The relative expressions of CEA mRNA and DDC mRNA in the preoperative peritoneal irrigation fluids of the A,B and C groups were compared respectively with those in the postoperative peritoneal irrigation fluids of the A,B and C groups,with no significant differences (F =1.651,0.681,1.381,1.179,1.309,1.321,P ＞0.05).The relative expressions of CEA mRNA and DDC mRNA in the preoperative peritoneal irrigation fluids of the D group were compared respectively with those in the postoperative peritoneal irrigation fluids of the D groups,with significant differences (F =46.228,7.455,P ＜ 0.05).One-hundred and four patients were followed up for a median time of 15.5 months (range,3.0-30.0 months) with a follow-up rate of 91.23％ (104/114).Among the 104 patients with follow-up,the 2-year cumulative survival rates of the A,B,C and D groups were 90.6％,83.3％,77.7％ and 64.0％,respectively,showing a significant difference in the survival among the 4 groups (x2 =14.600,P ＜0.05).The results of comparisons among the A,B and C groups showed no significant differences in the survival (x2=0.733,1.045,0.034,P ＞ 0.05).The survival in the D group was compared with those in the A,B and D groups,with significant differences (x2 =9.081,4.939,3.957,P ＜ 0.05).Conclusion Laparoscopic radical gastrectomy in patients with the area of serosal invasion ≤ 10 cm2 is safe and feasible,without increasing the rate of peritoneal micrometastases.
