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目的探讨肺癌术中有无肿瘤细胞的血行播散及其规律。方法对52例肺癌、5例肺部良性病变手术患者,于开胸时、结扎肺静脉时及结扎后1h取外周静脉血,结扎肺静脉时取肺静脉血,采用巢式逆转录聚合酶链反应(RTPCR)技术检测血中癌胚抗原(CEA)mRNA的表达量(以经内参照校正的紫外灯光下灰度值表示)。取人腺癌细胞系A549作阳性对照并检测该方法的灵敏度。结果CEAmRNA检测阳性率开胸时为31%(16/52),结扎肺静脉时外周血与肺静脉血、结扎肺静脉后1h外周静脉血均为54%(28/52),且病例一致。开胸时的CEAmRNA表达水平最低95±20,结扎肺静脉时肺静脉血最高126±22,结扎肺静脉时外周静脉血与结扎肺静脉后1h的外周静脉间差异无统计学意义(P>0.05)。CEAmRNA的术中阳性率,鳞癌患者为64%(14/22),腺癌患者为47%(14/30),阳性率与肿瘤性质无关(χ2=1.47,P>0.05);中央型肺癌的术中阳性率(80%,20/25)显著高于周围型肺癌(30%,8/27)(χ2=16.81,P=0.000);TNM分期Ⅰ、Ⅱ、Ⅲ、Ⅳ期者阳性率分别为32%(8/25),55%(6/11),93%(14/15)和0(0/1),分期较晚者显著高于分期较早者(χ2=17.93,P=0.000)。5例阴性对照均为阴性。经检验该方法的灵敏度为1×10-6。结论肺癌术中的确存在血行播散,结扎肺静脉的早晚可能对瘤细胞播散量有较大影响;中央型肺癌和
Objective To investigate the hematogenous dissemination and its regularity of tumor cells in the operation of lung cancer. Methods 52 patients with lung cancer and 5 patients with benign pulmonary disease underwent thoracotomy, ligating the pulmonary veins and peripheral blood 1 h after ligation, and pulmonary venous blood when the pulmonary veins were ligated. Nested reverse transcriptase polymerase chain reaction (RTPCR) ) Technique was used to detect the expression level of CEA mRNA in blood (expressed as gray value under UV light with internal reference correction). The human adenocarcinoma cell line A549 was taken as a positive control and the sensitivity of the method was tested. Results The positive rate of CEA mRNA was 31% (16/52) in thoracotomy. Peripheral blood and pulmonary venous blood volume in pulmonary vein ligation were 54% (28/52) at 1 hour after ligation of pulmonary vein, and the cases were the same. The lowest level of CEA mRNA was 95 ± 20 in thoracotomy, the highest in pulmonary venous blood was 126 ± 22 in ligation of pulmonary veins, and no significant difference was found between peripheral venous blood in ligation of pulmonary veins and peripheral venous lh after ligation of pulmonary veins (P> 0.05). The positive rate of CEA mRNA was 64% (14/22) in squamous cell carcinoma and 47% (14/30) in adenocarcinoma, the positive rate was not related to the nature of tumor (χ2 = 1.47, P> 0.05) (80%, 20/25) was significantly higher than that in peripheral lung cancer (30%, 8/27) (χ2 = 16.81, P = 0.000). The positive rates of TNM stage Ⅰ, Ⅱ, (8/25), 55% (6/11), 93% (14/15) and 0 (0/1) respectively. The later stage was significantly higher than the earlier stage (χ2 = 17.93, P = 0.000). All 5 negative controls were negative. After testing the sensitivity of the method is 1 × 10-6. Conclusions There is indeed a hematogenous dissemination in lung cancer surgery. Ligation of pulmonary veins may have a significant effect on the dissemination of tumor cells. Central lung cancer and