本文選題：結(jié)直腸癌　切入點：腸腔沖洗　出處：《江蘇大學》2017年碩士論文

【摘要】：目的:探討結(jié)直腸癌患者手術(shù)標本腫瘤臨近部位腸腔脫落腫瘤細胞檢測的陽性率及其與腫瘤分期、病理特征、腫瘤大小、腫瘤部位、手術(shù)時間、手術(shù)方式、患者性別、年齡的相關(guān)性,以期為術(shù)中遠端腸腔灌洗和或腸腔內(nèi)化療、腫瘤近遠端腸腔結(jié)扎等阻斷脫落腫瘤細胞的播散提供理論依據(jù)。方法:隨機選擇江蘇大學附屬醫(yī)院胃腸外科具有完整病例資料的96例結(jié)直腸癌患者,在腫瘤根治及標本離體后,將標本沖洗腸段結(jié)扎形成密閉腸腔,將預先抽滿30ml生理鹽水針筒連接具有側(cè)孔的軟管置入封閉腸段,以5ml/s的速度向密封腸段注入生理鹽水并反復抽吸及沖洗4~5次,取沖洗液立即離心,下層細胞沉淀分兩份,一份進行涂片、固定、HE染色,剩余部分采用血漿和凝血酶包裹成細胞軟凝塊,固定、脫水、浸蠟做成細胞蠟塊,切片后分別進行HE染色,光鏡下檢測細胞病理特征,有腫瘤細胞記錄為陽性,記錄兩種方法的最高結(jié)果為最終結(jié)果。建立Logistic回歸模型,將細胞學結(jié)果和其他臨床相關(guān)數(shù)據(jù)整理輸入SPSS17.0,用單因素初步分析腸腔脫落腫瘤細胞檢測陽性的相關(guān)因素,再將單因素分析具有相關(guān)性的影響因素繼續(xù)進行多因素分析其影響程度。結(jié)果:本研究中共納入96例結(jié)直腸癌病例,手術(shù)標本腫瘤臨近部位脫落腫瘤細胞陽性47例,陽性率為48.96%。單因素分析結(jié)果顯示患者腫瘤的大體類型、腫瘤大小、分化程度、TNM分期對結(jié)直腸癌腸腔脫落腫瘤細胞檢測陽性率的影響具有統(tǒng)計學意義(P0.05);而患者的性別、年齡、腫瘤部位、手術(shù)方式、手術(shù)時間對結(jié)直腸癌腸腔脫落腫瘤細胞檢測結(jié)果的影響不具有統(tǒng)計學意義(P0.05)。多因素分析結(jié)果顯示腫瘤的大體類型、腫瘤大小是影響腸腔脫落腫瘤細胞檢測陽性率的主要危險因素。其中隆起型(巨塊型、蕈傘型、隆起型)脫落細胞陽性率為20.8%,潰瘍型脫落細胞陽性率52.2%,浸潤型脫落細胞陽性率為68%,不同大體分型的脫落細胞陽性率之間差異具有統(tǒng)計學意義,P0.05。腫瘤直徑小于3cm,脫落細胞陽性率為15%,腫瘤直徑大于等于3cm小于6cm,脫落細胞陽性率為56.7%,腫瘤直徑大于等于6cm脫落細胞陽性率為60%,差異具有統(tǒng)計學意義,P0.05。結(jié)論結(jié)直腸癌腫瘤臨近腸腔存在腫瘤細胞脫落的現(xiàn)象,且腸腔灌洗脫落細胞學檢測總體陽性率為48.96%,這種檢測陽性率與腫瘤的大體類型、腫瘤大小、分化程度、TNM分期密切相關(guān)。因此,對可能存在腸腔脫落腫瘤細胞檢測陽性的結(jié)直腸癌患者手術(shù)時采取擴大切除范圍、腸段結(jié)扎、腸腔沖洗等有效手段阻隔或殺死游離腫瘤細胞、減少或防止局部復發(fā)具有一定臨床意義。
[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.
【學位授予單位】：江蘇大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R735.34

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