上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

电视胸腔镜和传统开胸术对非小细胞肺癌患者围手术期外周循环肿瘤细胞水平的影响

黄鸿渤1，谢廷洪2，苏明航2，宋元茂2，葛明建1   

  1. 1．重庆医科大学附属第一医院胸心外科， 重庆 400016； 2．贵州省遵义县人民医院外科， 遵义 563100
  • 出版日期:2014-08-28 发布日期:2014-09-02
  • 通讯作者: 葛明建, 电子信箱: mingjian_ge@hotmail.com。
  • 作者简介:黄鸿渤（1988—）， 男， 住院医师， 硕士生; 电子信箱: hhb51618zm@163.com。
  • 基金资助:

    重庆市卫生局医学科研项目（12-2）；贵州省遵义市科技局科研项目(2011-42)

Effects of video-assisted thoracoscopic surgery and conventional open thoracotomy on level of circulating tumor cells of patients with non-small-cell lung cancer during perioperative period

HUANG Hong-bo1, XIE Ting-hong2, SU Ming-hang2, SONG Yuan-mao2, GE Ming-jian1   

  1. 1.Department of Cardiothoracic Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016,China; 2.Department of Surgery, Zunyi City People's Hospital, Zunyi 563100, China
  • Online:2014-08-28 Published:2014-09-02
  • Supported by:

    Medical Research Project of Chongqing Municipal Health Bureau,12-2; Scientific Research Project of Zunyi Municipal Science and Technology Bureau, Guizhou Province, 2011-42

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摘要：

目的 动态观察围手术期非小细胞肺癌（NSCLC）患者外周循环肿瘤细胞（CTCs）的存在情况，并比较电视胸腔镜手术（VATS）和传统开胸手术对围手术期CTCs动态变化的影响。方法 将63例NSCLC患者随机分为VATS组（n=33）和传统开胸组（n=30），分别于术前第3日、术中及术后第3日采集8 mL外周血标本，经CD326（EpCAM）免疫磁珠阳性分选富集CTCs后，再行CK-PE、CD45-FITC荧光单克隆抗体标记，应用多参数流式细胞仪对CTCs进行定量检测。同时，以10例肺良性疾病者和10例健康志愿者为对照组。结果 63例NSCLC患者术前CTCs检测37例（58.73%）为阳性，对照组均为阴性。NSCLC患者术中CTCs水平显著高于术前，术后又高于术中，差异均有统计学意义（P<0.05或P<0.01）。VATS组与传统开胸组患者术前及术中的外周血CTCs水平比较差异均无统计学意义（P>0.05）；但VATS组患者术后外周血CTCs水平显著低于传统开胸组，且VATS组术前至术后时段CTCs水平增幅显著小于传统开胸组，差异均有统计学意义（P<0.05）。结论 相比于传统开胸手术，VATS肺叶切除术后CTCs水平增高幅度更小，可能有助于降低术后早期外周血中因手术播散的肿瘤细胞的存活率，使患者得到更好的长期生存率。

关键词: 非小细胞肺癌, 免疫磁珠, 流式细胞仪, 循环肿瘤细胞, 电视胸腔镜手术

Abstract:

Objective To observe the circulating tumor cells (CTCs) of patients with non-small-cell lung carcinoma (NSCLC) during the perioperative period and to compare the effects of video-assisted thoracoscopic surgery (VATS) and conventional open thoracotomy on the dynamic changes of CTCs. Methods Sixty-three patients with NSCLC were randomly divided into the VATS group (n=33) and conventional open thoracotomy group (n=30). Peripheral blood samples of 8 mL were collected during surgery, 3 d before and after surgery, respectively. CTCs were sorted and enriched by the CD326 (EpCAM) immunomagnetic cell enrichment and labeled by the fluorescent-labeled monoclonal antibodies CK-PE and CD45-FITC. The quantitative measurement of CTCs was conducted by the multi-parameter flow cytometry. Meanwhile, 10 patients with benign lung disease and 10 healthy volunteers were selected as controls. Results Thirty-seven of 63 (58.73%) patients with NSCLC were CTCs positive. The controls were all CTCs negative. For patients with NSCLC, the intra-operative CTC level was significantly higher than the preoperative CTC level and the postoperative CTC level was higher than the intra-operative CTC level. The differences were statistically significant (P<0.05 or P<0.01). The differences of preoperative and intra-operative CTC level of the VATS group and conventional open thoracotomy group were not statistically significant (P>0.05), but the postoperative CTC level of the VATS group was significantly lower than that of the conventional open thoracotomy group and  the increase of CTC level from preoperation to postoperation of the VATS group was significantly lower than that of the conventional open thoracotomy group. The differences were statistically significant (P<0.05). Conclusion Compared to the conventional open thoracotomy, the increase of postoperative CTC level of VATS is significantly lower, which may be helpful for reducing the survival of surgically disseminated tumor cells in the early postoperative period and improving the long-term survival of patients.

Key words: non-small-cell lung carcinoma, immunomagnetic beads, flow cytometry, circulating tumor cells, video-assisted thoracoscopic surgery