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目的探讨提高胃癌腹腔网膜囊亚临床转移诊断率的新方式。方法选取我科2012年1月至2013年10月胃癌手术患者58例,随机分为A、B两组。A组35例应用0.25%胰蛋白酶细胞消化液消化、冲洗胃网膜囊囊壁组织,B组23例采取生理盐水冲洗网膜囊囊壁组织。采用免疫组织化学法与HE染色法检测、对比58例胃癌患者网膜囊冲洗液中癌细胞及CEA、CK7、CK20和HPA的表达。结果 A组患者HE染色阳性16例,阳性率45.71%,免疫组化染色阳性29例,阳性率82.86%。B组患者HE染色阳性4例,阳性率17.39%。免疫组化染色阳性11例,阳性率47.83%。两组数据间差异具有统计学意义(P<0.01)。胰蛋白酶消化冲洗液肿瘤标志物相关分析中,CEA阳性表达与HPA阳性表达呈正相关(r=0.488,P<0.01),CEA阳性表达与CK7阳性表达呈正相关(r=0.389,P<0.05),CEA阳性表达与CK20阳性表达无相关(r=0.299,P>0.05),CK7、CK20及HPA三者阳性表达呈正相关(P<0.05)。结论胰蛋白酶细胞消化液网膜囊冲洗可提高胃癌腹腔亚临床转移的诊断率,免疫组化联合检测CEA、CK7、CK20及HPA,较单个肿瘤标志物检测胃癌腹腔网膜囊亚临床转移敏感性高。
Objective To explore a new way to improve the diagnostic rate of subclinical metastasis of gastric peritoneal omentum. Methods Fifty-eight patients with gastric cancer who underwent surgery from January 2012 to October 2013 in our department were randomly divided into A and B groups. A group of 35 patients with 0.25% trypsin digestion digestion, gastric wall tissue flushed, B group, 23 cases of normal saline flushed omentum capsule wall tissue. Immunohistochemistry and HE staining were used to detect the expression of CEA, CK7, CK20 and HPA in cancer cells and omentum in 58 patients with gastric cancer. Results A group of patients with positive staining of 16 cases of HE, the positive rate of 45.71%, immunohistochemical staining in 29 cases, the positive rate of 82.86%. In group B, HE staining was positive in 4 cases, the positive rate was 17.39%. Immunohistochemical staining in 11 cases, the positive rate was 47.83%. The difference between the two groups of data was statistically significant (P <0.01). CEA positive expression was positively correlated with HPA positive expression (r = 0.488, P <0.01), and positive correlation between CEA positive expression and CK7 positive expression (r = 0.389, P <0.05) in the correlation analysis of tumor marker of trypsin digestion washing fluid, The positive expression of CEA was not correlated with the expression of CK20 (r = 0.299, P> 0.05), but positively correlated with CK7, CK20 and HPA (P <0.05). Conclusion Trypsin digestion and reticular cyst irrigation can improve the diagnosis of subclinical gastric cancer metastasis. Immunohistochemical detection of CEA, CK7, CK20 and HPA is more effective than single tumor markers in detection of subclinical metastasis of gastric peritoneal network high.