结直肠癌肠腔脱落肿瘤细胞的检测及相关因素分析和临床意义

发布时间：2018-03-27 19:10

本文选题：结直肠癌　切入点：肠腔冲洗　出处：《江苏大学》2017年硕士论文

【摘要】：目的:探讨结直肠癌患者手术标本肿瘤临近部位肠腔脱落肿瘤细胞检测的阳性率及其与肿瘤分期、病理特征、肿瘤大小、肿瘤部位、手术时间、手术方式、患者性别、年龄的相关性,以期为术中远端肠腔灌洗和或肠腔内化疗、肿瘤近远端肠腔结扎等阻断脱落肿瘤细胞的播散提供理论依据。方法:随机选择江苏大学附属医院胃肠外科具有完整病例资料的96例结直肠癌患者,在肿瘤根治及标本离体后,将标本冲洗肠段结扎形成密闭肠腔,将预先抽满30ml生理盐水针筒连接具有侧孔的软管置入封闭肠段,以5ml/s的速度向密封肠段注入生理盐水并反复抽吸及冲洗4~5次,取冲洗液立即离心,下层细胞沉淀分两份,一份进行涂片、固定、HE染色,剩余部分采用血浆和凝血酶包裹成细胞软凝块,固定、脱水、浸蜡做成细胞蜡块,切片后分别进行HE染色,光镜下检测细胞病理特征,有肿瘤细胞记录为阳性,记录两种方法的最高结果为最终结果。建立Logistic回归模型,将细胞学结果和其他临床相关数据整理输入SPSS17.0,用单因素初步分析肠腔脱落肿瘤细胞检测阳性的相关因素,再将单因素分析具有相关性的影响因素继续进行多因素分析其影响程度。结果:本研究中共纳入96例结直肠癌病例,手术标本肿瘤临近部位脱落肿瘤细胞阳性47例,阳性率为48.96%。单因素分析结果显示患者肿瘤的大体类型、肿瘤大小、分化程度、TNM分期对结直肠癌肠腔脱落肿瘤细胞检测阳性率的影响具有统计学意义(P0.05);而患者的性别、年龄、肿瘤部位、手术方式、手术时间对结直肠癌肠腔脱落肿瘤细胞检测结果的影响不具有统计学意义(P0.05)。多因素分析结果显示肿瘤的大体类型、肿瘤大小是影响肠腔脱落肿瘤细胞检测阳性率的主要危险因素。其中隆起型(巨块型、蕈伞型、隆起型)脱落细胞阳性率为20.8%,溃疡型脱落细胞阳性率52.2%,浸润型脱落细胞阳性率为68%,不同大体分型的脱落细胞阳性率之间差异具有统计学意义,P0.05。肿瘤直径小于3cm,脱落细胞阳性率为15%,肿瘤直径大于等于3cm小于6cm,脱落细胞阳性率为56.7%,肿瘤直径大于等于6cm脱落细胞阳性率为60%,差异具有统计学意义,P0.05。结论结直肠癌肿瘤临近肠腔存在肿瘤细胞脱落的现象,且肠腔灌洗脱落细胞学检测总体阳性率为48.96%,这种检测阳性率与肿瘤的大体类型、肿瘤大小、分化程度、TNM分期密切相关。因此,对可能存在肠腔脱落肿瘤细胞检测阳性的结直肠癌患者手术时采取扩大切除范围、肠段结扎、肠腔冲洗等有效手段阻隔或杀死游离肿瘤细胞、减少或防止局部复发具有一定临床意义。
[Abstract]:Objective: to investigate the positive rate of exfoliative tumor cells in adjacent lumen of colorectal cancer patients and its correlation with tumor staging, pathological features, tumor size, tumor location, operation time, operation mode and patient sex. Age correlation, with a view to intraoperative distal lumen lavage and or intracavitary chemotherapy, Methods: 96 patients with colorectal cancer with complete data of gastrointestinal surgery in Jiangsu University Hospital were randomly selected. The specimen was washed and ligated to form a closed intestinal cavity. The hose with lateral holes was connected with the 30ml syringe and inserted into the closed intestinal segment. Saline was injected into the sealed intestine at the speed of 5ml/s and was sucked and flushed for 45 times. The washing fluid was immediately centrifuged and the lower layer cells were precipitated in two parts. One part was smeared and fixed with HE staining. The remaining part was coated with plasma and thrombin to form a cell soft clot, fixed, dehydrated, and waxed into a cell wax block. After the sections were stained with HE respectively, the pathological features of the cells were examined under light microscope. The tumor cells were recorded as positive, and the highest results of the two methods were recorded as the final results. The Logistic regression model was established. The cytological results and other clinical data were collected and inputted into SPSS 17.0. the factors related to the positive detection of exfoliated tumor cells in intestinal cavity were analyzed by univariate analysis. Results: 96 cases of colorectal cancer were included in this study, and 47 cases of tumor cells exfoliated in adjacent parts of the tumor were positive. The positive rate was 48.96.The results of univariate analysis showed that the gross type, tumor size, and TNM stage of tumor differentiation had statistical significance on the positive rate of exfoliated tumor cells in colorectal cancer (P 0.05), and the sex, age, age of the patients. The effect of tumor location, operation method and operation time on the detection of tumor cells in colorectal cancer was not statistically significant (P 0.05). The results of multivariate analysis showed the gross types of tumors. The size of tumor is the main risk factor to determine the positive rate of tumor cells in intestinal cavity exfoliation. The positive rate of exfoliated cells was 20.8%, that of ulcer type was 52.2%, that of infiltrating exfoliated cells was 68%. The difference of exfoliated cells in different gross types was statistically significant (P0.05). The diameter of tumor was less than 3 cm, and the positive rate of exfoliated cells was less than 3 cm. The positive rate of tumor was 15cm, the diameter of tumor was greater than 3cm less than 6 cm, the positive rate of exfoliated cells was 56.7, and the positive rate of exfoliated cells was 60. The difference was statistically significant (P0.05.Conclusion Colorectal cancer is near intestinal cavity. The phenomenon of tumor cells falling off, The total positive rate of exfoliative cytology was 48.96. The positive rate was closely related to the gross type, tumor size, differentiation degree and TNM stage of the tumor. In patients with colorectal cancer who may have positive exfoliative tumor cells in the lumen, the removal range should be enlarged, the intestinal segment ligated, the intestinal cavity flushed, and other effective means should be taken to block or kill the free tumor cells. It is of clinical significance to reduce or prevent local recurrence.
【学位授予单位】：江苏大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.34

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