胃癌根治术胰腺被膜清除的探讨

目的:探讨胃癌微转移发生的因素和微转移的规律,为建立个体化的手术治疗方案提供更可靠的依据。方法:结合哈尔滨医科大学附属第四医院普外科2007年1月至2008年7月期间行开腹(78例)及腹腔镜(5例)胃癌根治术清扫胰腺被膜病人的临床资料,利用组织细胞病理学、免疫组化及PCR等方法分析选择性清除胰腺被膜的价值。结果:83例胃癌病人的胰腺被膜组织常规病理HE染色均未见癌细胞,而CK20和CEA检测的阳性率为24.1%(20/83)和26.5%(22/83);CK20 mRNA和CEA mRNA阳性率为分别为50.6%(42/83)和38.6%(32/83)。胃癌胰腺被膜转移与肿瘤的浸润深度、病理分型、临床分期、淋巴结转移有关(P0.05),而与病人的年龄和性别无关(P0.05)。结论:胃癌根治术应有选择地清除胰腺被膜。

Investigation concerning whether the capsule of the pancreas should be included in the radical surgery of distal gastric cancer

Objective To investigate the fields of micrometastasis in gastric cancer,for the establishment of reliable basis in individualized surgical treatment options.Methods From January 2007 to July 2008,78 cases of open radical gastrectomy and 5 cases of laparoscopic resection of gastric cancer were performed;the inclusion of the pancreatic capsule was within the scope of radical surgery.Tissue pathology,immunohistochemistry and PCR were used to confirm whether laparoscopic radical gastrectomy should include the removal of the pancreas capsule.Results The regular pathology is negative in all the 83 patients,but CK20 and CEA positive cells were found in the pancreatic capsule of 20 patients（24.1%） and 22 patients（26.5%） respectively;while CK20 mRNA and CEA mRNA positive cells were found in the pancreatic capsule of 42 patients（50.6%） and 40 patients（38.6%） respectively.The metastasis in pancreatic capsule is mainly correlated with the invasive serous membrane,pathological type,lymph node metastasis and tumor stage（P0.05） and not correlated with sex and age（P0.05）.Conclusion The capsule of the pancreas should be inclusively dissected in the radical surgery of distal gastric cancer,regardless of the type of procedure employed.