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目的:研究胃癌患者腹膜微转移的相关因素及临床意义,为临床手术切除范围探寻理论依据。方法:应用CK19和CK20免疫组织化学方法,检测62例胃癌患者横结肠系膜前叶、胰腺被膜、网膜囊后壁和盆底腹膜组织,并与HE染色及腹腔灌洗液细胞学检查对比。结果:62例胃癌患者的腹膜组织常规病理HE染色均未见癌细胞,免疫组织化学证实腹膜微转移阳性率为43.55%(27/62),远高于腹腔灌洗液癌细胞的14.52%(9/62)。胃癌腹膜微转移与肿瘤的大小、浸润深度、临床分期、淋巴结转移有关(P<0.05),而与肿瘤的部位、患者年龄、性别无关(P>0.05)。结论:用免疫组化方法检测胃癌腹膜微转移,可为胃癌根治术术式的选择和术后综合治疗提供可靠依据。对于进展期胃癌患者,应常规腹膜取材检测微转移,多点取材有助于提高微转移检出率。
Objective: To study the related factors and clinical significance of peritoneal micrometastasis in patients with gastric cancer and to explore the theoretical basis for the scope of clinical surgical resection. Methods: The CK19 and CK20 immunohistochemical methods were used to detect the transmembrane mesangial membrane, the pancreas capsule, the posterior wall of the omental membrane and the peritoneum in the pelvic floor of 62 patients with gastric cancer, and compared with HE staining and peritoneal lavage fluid cytology. Results: The results of immunohistochemistry showed that the positive rate of peritoneal micrometastasis was 43.55% (27/62) in the peritoneal tissue of 62 gastric cancer patients, which was much higher than that of the peritoneal lavage fluid cancer cells (14.52% 9/62). The peritoneal micrometastasis in gastric cancer was related to tumor size, depth of invasion, clinical stage and lymph node metastasis (P <0.05), but not to tumor location, patient age and sex (P> 0.05). Conclusion: The detection of peritoneal micrometastases in gastric cancer by immunohistochemistry can provide a reliable basis for the choice of radical operation and comprehensive treatment of gastric cancer. For patients with advanced gastric cancer, conventional peritoneal sampling should be used to detect micrometastasis, and multi-point drawing will help improve the detection rate of micrometastases.