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目的探讨中上段直肠癌术中盆腔冲洗液细胞学检查及免疫组化的应用价值。方法对我院46例中上段直肠癌患者,进行术中盆腔冲洗,将盆腔冲洗液作脱落细胞涂片检查并进行免疫组化染色。结果中上段直肠癌患者,应用盆腔冲洗液细胞学检查,癌细胞检出率82.6%,脱落癌细胞表达CK低(低分子量角蛋白),CEA(癌胚抗原),不表达vimentin(波形蛋白抗原)、CR(钙结合蛋白抗原)及MC(间皮细胞抗原),其中vimentin、CEA、CR、MC蛋白表达与否及Ki-67(细胞增殖核抗原)表达率对癌细胞与创伤间皮细胞具有鉴别诊断作用,差异有显著性(P<0.001),脱落癌细胞与组织学分化程度差异无统计学意义(P>0.05),脱落癌细胞Ki-67表达率与肿瘤分化程度无统计学意义(P>0.05)。结论中上段直肠癌术中盆腔冲洗液细胞学检查及免疫组化对确定盆腔冲洗液中癌细胞、手术方式、后续治疗及预后具有重要意义。
Objective To investigate the value of pelvic washing fluid cytology and immunohistochemistry in the middle and upper rectal cancer. Methods 46 cases of upper rectal cancer patients in our hospital, intraoperative pelvic flushing, pelvic washing fluid for exfoliated cell smears and immunohistochemical staining. Results In the middle and upper rectal cancer patients, the detection rate of cancer cells was 82.6% by using pelvic washing liquid cytology. The cancerous cells expressed CK low (low molecular weight keratin), CEA (carcinoembryonic antigen), no vimentin (vimentin antigen ), CR (calcium binding protein antigen) and MC (intercellular antigen), which vimentin, CEA, CR, MC protein expression and Ki-67 (proliferating cell nuclear antigen) expression rate of cancer cells and traumatic mesothelial cells (P <0.001). There was no significant difference in the degree of histological differentiation between cancerous cells and cancerous cells (P> 0.05). There was no significant difference in the expression rate of Ki-67 between cancerous cells and tumor differentiation (P> 0.05). Conclusions Intraoperative cytology and immunohistochemistry of pelvic irrigation fluid in the middle and upper rectal cancer are of great significance for the determination of cancer cells in pelvic irrigation fluid, surgical approach, follow-up treatment and prognosis.