【摘要】 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.更多还原

【Abstract】 AIM: To assess whether surgical manoeuvre or resection of lung cancer could lead to haematogenous dissemination of malignant cells, to monito the quantity and timing of the shedding of lung cancer cells into the circulation of patients by fqRT-PCR before, during and after surgery, and to determine the relationship between the sequence of vessel ligation and the haematogenous dissemination of cancer cells during operation. METHODS: Sixty-nine peripheral blood samples were collected 1 d before operation, during operation and 7 d after operation from 23 consecutive patients with non-small cell lung cancer who underwent surgical resection with curative intention. All patients were randomly assigned before the operation to 2 surgical procedure groups according to the order of vessel ligation （PV-first group and PA-first group）. Additionally, 10 patients with benign lung disease served as control subjects undergoing surgical resection. All the peripheral blood samples were subjected to fqRT-PCR with carcinoembryonic antigen as marker. RESULTS: The level of CEA mRNA in peripheral blood （PB） ascended conti- nuously within this period. The postoperative value （D₇） was significantly higher than that of preoperation （D -1 ） （P=0.000） and that of operative day （D₀） （P=0.000）. There was a striking difference between adenocarcinoma and squamous carcinoma （P=0.0375）. The values of CEA mRNA in PB between PV-first group and PA-first group were significantly different （P=0.045）. At the same time, there was a correlation between preoperative T-stage and perioperative CEA mRNA in PB （P= 0.025）. Among the 23 cases , 10 cases were positive （43.5%）. Both the control subjects and the volunteers were negative. CONCLUSION:A considerable proportion of patients who appear to have resectable non-small cell lung cancer might be regarded as having systemic disease, which is often undetectable by current tumour staging method. CEA-expressing tumour cells are disseminated mostly postoperatively, which may potentially be the source of recurrence or metastases. Surgical manipulation can promote the release of tumour cells into the blood stream, but the ligation of PV before the ligation of the PA may partly prevent such release during surgery.更多还原