【作者】 李步云；

【导师】 张长乐； 刘弋；

【作者基本信息】 安徽医科大学 ， 外科学， 2002， 硕士

【摘要】 目的 通过研究不同类型胃粘膜上皮、胃癌组织、淋巴结、转移淋巴结、Douglas陷窝腹膜以及种植转移灶中CD44V6的表达情况探讨其作为一项指标在胃癌的分子诊断、分子定界、分子分期及分子预后中应用的可能性并且将之与HE染色结合评价RIGS手术的可行性。方法2001.3.1-2002.3.1，共30例胃镜下及病理证实为胃癌的病人进入治疗组，其中男21例，女9例，年龄范围44-72岁，平均年龄59±8岁，术前采用了¹³¹I标记的胃癌单克隆抗体3H₁₁在胃镜下注射入瘤体四周，注射后4-8天进行手术。术中以GDP分别探测胃癌原发灶、切缘、吻合口、肝、脾、各组淋巴结、盆腔等组织，并将探测结果仔细记录。30人均进行了根治性手术。术后将标本组织以及30例正常的胃粘膜组织、50例异型增生组织、良性疾病取材的淋巴结及腹膜各20例的CD44V6的表达情况应用免疫组化方法进行分析及对比。并将其表达情况与血清CEA的检测结果进行比较。结果 （1）正常胃粘膜、良性疾病淋巴结和腹膜不表达CD44V6，而异型增生组织，胃癌组织、转移淋巴结和Douglas腹膜种植转移灶表达CD44V6。而且异型增生与胃癌组织间CD44V6表达强度有显著性差异；（2）CD44V6的表达与胃癌的生长方式、TNM分期、淋巴结转移、脉管浸润和胃癌癌灶浸润深度密切相关；（3）胃癌组织CD44V6的表达率为76.7％，转移淋巴结为88.64％；（4）CD44V6免疫组化与HE结合应用评价RID对胃癌原发灶、切缘、吻合口、转移淋巴结及Douglas陷窝种植转移的准确率分别达到100％，100％，100％，92.43％和83.3％：（5）RID探测结果结合CD44V6免疫组化与HE染色对胃癌TNM分期结果与传统分期方法是有统计学差异的；（6）CD44V6阳性组术后血清CEA阳性率较阴性组高并具有显著性差异。结论 （1）CD44V6与胃癌的发生发展密切相关。CD44V6的表达可以反映胃癌细胞具有较恶的生物学行为。CD44V6可以作为一项指标应用于胃癌的分子诊断、分子定界、分子分期和分子预后中；（2）RIGS可以作为一项可靠的技术应用 安徽医科大学硕士学位论文 于胃癌的治疗中，但仍然存在一定的假阳性和假阴性率，需要进一步的改进。更多还原

【Abstract】 OhieCtive To discuss the POssibility to aPP1y the CD44V6 prowin as anindex in molecule diagnosis, demarkng, stage and prognosis of gaStric cancer bycomParing with the exPression of CD44V6 in different tyPes of gastric mucosa, lymphnode and PeritOneum of Douglas lacuna. To estimate the feaSibility of RIGS to beaPPlied in gastric cancer by CD44V6 immunohistochemisty and HE. Methods FromMarCh. 200l to March. 2002, 30 Patients of gastric cancer verifided by gaStrscopy andhiStology were accepeted in the theraPeutic grouP, 2l were male and 9 were female. Theage ranges frOm 44 to 72 years, the average was 59i8 years. The monocolone of..,gastnc carcinoma, 3H11 markd by ’3’I was injected thrOugh g8stroscOPy aroundcancerous focus PreOpehoon. OPerations were PerfOnned 4 to 8 days later The gaInInadectecting Probe was used in the oPeration to deteC the Primp cancer and itsdissemination. The resultS wer reCOrdd wicularly in the PrOCess of laparotmy AllPatients Wrwent radical resection. Serum CEA is also be coInPared betWeen CD44V6POsitlye and CD4V6 negative grOUs Pre and POst OPeraon. Resube (l) NormalgaStric mucosa, lyInPh node and perioneum of benign disease dO not exPress CD44V6.The POsitive rate of CD44V6 exPression in cancer was sitwficantiy higher than tha ofdysPlasia. (2) The exPession of ooV6 was sighficanti cOndated with the gaStriccancer infiltraive grOwth Pattrw lymPh node metaStasis, vessel invasion, dePth ofinvasion and the stage of M. (3) The exPression rate of CD44V6 was 76.7% and88.64% in Primary focus and lyInPh nodes resPectivey (4) The detechng accurmp ofto to Primeq fOcus, inciSa margins, anastomOtic stomp metastatic lymPh nodes andinplantaion fOCus in Douglas lacuna was l00%, l00%, l00%, 92.43% and 83.3%resPeCtively (5) Result of ryM Stag was sighfiCanly different betwen conventionalmethod and standard method. (6) The POsitive rate of CEA in CD44V6 POsitive grOuPwas significantly higher than that of CD44V6 negative group postoperation, which may indicate that patients of CD44V6 positive expression have a worse prognosis. Conclusion (l)The expression of CD44V6 was correlated with the gastric carcinogenesis and progression. And it can reflect the malignant behavior of tumor cells of gastric cancer. CD44V6 can be used as an indicator to be applied in the molecule diagnosis, demarking and prognosis of gastric cancer. (2)RIGS can be applied in the areas of therapy of gastric cancer as a dependable technology and it should be further improved because of its false positive and negative rate.更多还原