目的:动态观察围手术期非小细胞肺癌(NSCLC)患者外周循环癌细胞(circulating tumor cells,CTCs)的存在状况,评价手术操作促进癌细胞入血的可能性,寻找术中血管结扎顺序与CTCs数量变化问的相关性。方法:按预定的结扎血管顺序术前将23例接受根治性手术的原发性NSCLC患者随机分为先结扎肺静脉组和先结扎肺动脉组,分别采集其术前1天、术中及术后第7天的外周血标本。以角蛋白19(CK19)作为标志物,运用实时荧光定量逆转录-聚合酶链反应(fqRT-PCR)法定量检测各时点外周血中CK19 mRNA水平。选择10例需手术治疗的肺部良性疾病患者作为手术对照;以20例健康人作为阴性对照。结果:肺癌患者CK19术中测值显著高于术前1 d(5．2464±0．196vs 4．472±0．164,P<0．001)及术后7 d(5.246±0．196 vs 4．694±0．177,P=0．013)。肺腺癌与鳞癌比较有显著差异(4．911±1．032 vs 4．1891±0．413,t=2．364,P=0．028)。围手术期先结扎肺静脉组与先结扎肺动脉组比较有明显差异(4．503vs 5．085,P=0．086)。以健康对照组均值的95％可信区间的上界限为分界值,若测得值>4．120为阳性。14例肺癌患者术前结果为阳性(60．9％):2例接受手术的肺部良性疾病患者出现术中正常上皮细胞入血。结论:人表达CK19 mRNA的癌或上皮细胞主要在术中入血。外科手术操作可促使癌细胞术中入血,若先结扎肺静脉可一定程度上减少肺癌细胞入血。 OBJECTIVE: To dynamically observe the presence of circulating tumor cells (CTCs) in patients with perioperative non-small cell lung cancer (NSCLC) and to evaluate the possibility of surgical operation in promoting the infiltration of cancer cells. To search for the relationship between intraoperative vascular ligation sequence and CTCs Correlation of quantitative changes. Methods: Twenty-three primary NSCLC patients undergoing radical surgery were randomly divided into pre-ligation of pulmonary vein group and ligation of pulmonary artery group according to pre-determined ligation sequence. One day before surgery, 7 days of peripheral blood samples. Cytokeratin 19 (CK19) was used as a marker to detect the level of CK19 mRNA in peripheral blood at each time point by real-time fluorescence quantitative reverse transcription-polymerase chain reaction (fqRT-PCR). Ten patients with benign lung diseases requiring surgical treatment were selected as surgical controls and 20 healthy individuals as negative controls. Results: The CK19 intraoperative measurement in patients with lung cancer was significantly higher than that before operation (5.2464 ± 0.196 vs 4.472 ± 0.164, P <0.001) and 7 days after operation (5.246 ± 0.196 vs 4.694 ± 0.177, P = 0.013). There were significant differences between lung adenocarcinoma and squamous cell carcinoma (4.911 ± 1.032 vs 4.1891 ± 0.413, t = 2.364, P = 0.028). There was a significant difference (4.503 vs 5.085, P = 0.086) between perioperatively ligating the pulmonary vein group and the first ligation of the pulmonary artery group. The upper limit of the 95% confidence interval for the mean of the healthy control group was taken as the cut-off value, with a positive value of> 4.120. Fourteen patients with lung cancer had a positive preoperative result (60.9%): Two patients with benign lung disease undergoing surgery had intraoperative normal epithelial cell infiltration. CONCLUSION: Human cancerous or epithelial cells that express CK19 mRNA predominantly bleed during surgery. Surgery can promote the operation of cancer cells into the blood, if the first ligation of pulmonary veins can reduce lung cancer cells to a certain extent, into the blood.