原发性肝细胞癌术中脱落癌细胞污染手术用物78例分析

摘要

Objective To investigate the risks of operative contamination of surgical gear by exfoliated cancer in 78 patients who received surgery for hepatocellular carcinoma.Methods Surgical gear from 78 patients who were operated for primary hepatocellular carcinoma were divided into four groups:A.surgical instruments; B.surgeon gloves; C.gauze and gloves used for cleaning equipment; D.gauze and gauze pad used for cleaning operation area.Saline was used to soak the surgical gear followed by low speed centrifugation.The precipitate was stained and then observed for cancer cells.Results The positive rates of cancer cell on surgical gear were significantly associated with the TNM stage,tumor location,tumor size,and surgical approach.The positive rate of liver cancer cell on surgical gear in TNM stage Ⅲ was higher than TNM stage Ⅰ / Ⅱ (56.3％ vs 21.7％,P=0.002).The positive rate of cancer cell on surgical gear was significantly related to tumor size and location (P=0.006,P=0.001).The positive cancer cell detection rate of non-anatomical liver resection was significantly higher than anatomical resection (53.8 ％ vs 26.9 ％,P =0.019).The positive cancer cell detection rate was significantly associated with different types of surgical gear (P=0.008),in which group C showed the highest cancer cell detection rate.Conclusion The risks of cancer cell contamination of surgical gear were significantly associated with progression of hepatocellular carcinoma,tumor size,location and surgical approach,and also associated with the frequency in the use of surgical gear,the operation scope of contact and the nature of surgical gear.%目的 探讨原发性肝细胞癌术中手术用物携带脱落癌细胞的情况.方法 78例原发性肝细胞癌术中用物分四组:A.手术器械；B.术者手套；C.器械护士手套及擦器械、回收残线的纱条；D.清洁术野的纱条、纱垫.术中用物生理盐水浸泡、低速离心后,沉淀物瑞氏染色观察,携带癌细胞者为阳性用物.结果 手术用物癌细胞阳性检出率与TNM分期、肿瘤位置、肿瘤大小以及手术方式显著相关.TNM分期Ⅲ期肝癌手术用物癌细胞阳性检出率较Ⅰ、Ⅱ期用物高(56.3％比21.7％,P=0.002)；肿瘤位置、大小与手术用物癌细胞阳性检出率显著相关(P=0.003,P=0.001)；不规则性肝切除癌细胞检出率显著高于规则性切除(53.8％比26.9％,P=0.019).而且不同的手术用物间癌细胞阳性检出率有显著差异(P=0.008),C组用物癌细胞检出率最高.结论 术中用物癌细胞污染程度与肝细胞癌分期进展、肿瘤位置、大小以及手术方式明显相关,且随用物使用频率、接触范围增加而增加,与用物性质密切相关.