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目的:评价手术操作促进肺癌细胞入血的可能性,分析围手术期外周循环癌细胞(CTCs)的变化与常见临床病理指标间的关系.方法:接受根治性手术的原发性非小细胞肺癌(NSCLC)患者23例,按预定的结扎血管顺序术前将病例任意分为先结扎肺静脉组和先结扎肺动脉组.分别采集其术前1d、术中及术后第7日外周血标本.选择10例需手术治疗的肺部良性疾病患者作为对照.以20例健康人作为阴性对照.以癌胚抗原(CEA)作为检测标志物,运用实时荧光定量逆转录-聚合酶链反应(fqRT-PCR)法定量检测患者CTCs的存在状况.结果:围手术期外周血CEAmRNA浓度变化呈上升趋势,术后第7日显著高于术前1d(P=0.000)及手术当天(P=0.000).肺腺癌术前CEAmRNA明显高于肺鳞癌(P=0.0375).先结扎肺静脉组与先结扎肺动脉组比较存在明显差异(P=0.045).术前T-分期与围手术期CEA测值间亦存在密切关系(P=0.025).术前阳性率为43.5%(10/23),而手术对照组及健康组均为阴性.结论:可手术切除的NSCLC患者手术前就可能存在全身癌细胞的播散.肺癌细胞主要在术后逐渐释放入外周循环.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阻止癌细胞释放.
OBJECTIVE: To evaluate the possibility of surgical operation in promoting lung cancer cells into the blood and to analyze the relationship between perioperative changes of peripheral circulating cancer cells (CTCs) and common clinicopathological parameters.Methods: Primary non-small cell lung cancer (NSCLC) patients were divided into two groups according to the order of ligation of blood vessels before operation: the group of pulmonary vein was ligated first and the group of pulmonary artery was ligated first.The peripheral blood samples were collected on the first day before operation and on the seventh day after operation. Twenty patients with benign lung diseases undergoing surgery were selected as controls, and 20 healthy controls were used as negative controls.Cear CEA was used as a detection marker and real-time fluorescent quantitative reverse transcription-polymerase chain reaction (fqRT-PCR) ) Was used to detect the presence of CTCs in patients.Results: Perioperative CEA mRNA levels in peripheral blood showed an increasing trend, which was significantly higher than that on the 7th day (P = 0.000) and on the day of surgery (P = 0.000) The preoperative CEAmRNA in adenocarcinoma was significantly higher than that in squamous cell carcinoma of the lung (P = 0.0375). There was a significant difference (P = 0.045) between the group of pulmonary vein before ligation and the group of pulmonary artery ligation There is a close relationship (P = 0.025) 43.5% (10/23), respectively, while the control group and the healthy group were negative.Conclusion: There may be dissemination of whole body cancer cells in the resectable NSCLC patients before surgery.Lung cancer cells are gradually released into the peripheral circulation Surgery can promote the operation of cancer cells into the bloodstream, if the first ligation of the pulmonary vein to a certain extent, prevent the release of cancer cells.