作者：彭耀辉1，熊文俊2，徐钰婷1，罗思静1，李金2，郑燕生2，罗立杰2，黄海鹏2，陈妍1，曾海平1，王伟2

单位：1. 广州中医药大学 第二临床医学院，广东 广州 510120； 2. 广州中医药大学第二附属医院广东省中医院 胃肠外科，广东 广州510120

Authors:  Peng Yaohui1, Xiong Wenjun2, Xu Yuting1, Luo Sijing1, Li Jin2, Zheng Yansheng2, Luo Lijie2, Huang Haipeng2, Chen Yan1, Zeng Haiping1, Wang Wei2

Unit:  1.The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou 510120, Guangdong, China； 2.Department of Gastrointestinal Surgery, the Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou 510120, Guangdong, China

摘要：

目的   探讨晚期胃癌腹膜转移患者中腹腔脱落细胞学阳性的相关影响因素。方法  纳入2017年6月至2020年6月在广东省中医院住院且病理明确为胃癌腹膜转移的患者60例,通过腹腔镜探查收集冲洗液并行腹腔冲洗细胞学检查(peritoneal lavage cytology, PLC)。收集患者的性别、年龄、临床T分期、肿瘤部位、Borrmann分型、Lauren分型、腹水量、PCI、分化程度等,进行单因素和多因素分析,总结腹腔脱落细胞学检查阳性的相关影响因素。结果  60例患者的PLC阳性检出率为70%(42/60)。单因素分析发现,不同肿瘤部位、Lauren分型、腹水量、PCI、分化程度之间PLC阳性检出率差异有统计学意义差异(P<0.050)。进一步多因素分析发现,PCI、腹水量是晚期胃癌腹膜转移患者的独立影响因素P<0.05)。结论  PLC阳性检出率与晚期胃癌腹膜转移的实际情况存在一定差异。腹腔脱落细胞学检查的主要影响因素有PCI、腹水量。关于晚期胃癌腹膜转移的诊断方面,单纯的PLC检查可能尚有欠缺,临床漏诊率较高,必要时仍需进一步的腹腔镜探查辅助明确诊断。

关键词：  腹腔冲洗细胞学检查; 胃癌; 腹膜转移; 阳性检出率

Abstract：

Objective In order to investigate the influencing factors of the positive result of Peritoneal lavage cytology in patients with advanced gastric cancer with peritoneal metastasis. Methods From June 2017 to June 2020, 60 patients who were hospitalized in the Guangdong Provincial Hospital of Traditional Chinese Medicine, and whose pathology was confirmed to be gastric cancer and peritoneal metastasis were enrolled. All patients using diagnostic laparoscopy to collect washing fluid for peritoneal lavage cytology (PLC). Collecting the clinical data such as patient’s gender, age, clinical T stage, the tumor site, Borrmann classification, Lauren classification, ascites, PCI, and the degree of tumor differentiation and so on, which for the single-factor and multi-factor analysis, and summarized the relevant influencing factors of positive abdominal exfoliation cytology. Results The positive detection rate of PLC in 60 patients was 70% (42/60). Single-factor analysis found that there were statistically significant differences in the positive detection rate of PLC among different tumor locations, Lauren classification, ascites volume, PCI, and degree of differentiation factors in patients with advanced gastric cancer and peritoneal metastasis(P<0.05). Conclusion There is a certain difference between the positive detection rate of PLC and the actual situation of advanced gastric cancer with peritoneal metastasis. The main influencing factors of peritoneal lavage cytology are PCI and ascites volume. Regarding the diagnosis of advanced gastric cancer with peritoneal metastasis, the simple PLC examination may still be lacking, and the clinical missed diagnosis rate is relatively high. If necessary, further laparoscopic exploration is needed to assist in the diagnosis.

Key Words:  Peritoneal lavage cytology; Gastric cancer; Peritoneal metastasis; Positive detection rate