Ajki Tetsuo, Fujita Tsunenori, Matsumoto Ippei, Yasuda Takeo, Fujino Yasuhiro, Ueda Takashi, Suzuki Yasuyuki, Kuroda Yoshikazu, Ku Yonson
Department of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medical Sciences, Chuo-ku, Kobe, Japan.
Hepatogastroenterology. 2008 May-Jun;55(84):842-5.
BACKGROUND/AIMS: Evaluation of peritoneal cytology provides valuable prognostic information in abdominal cancers. The aim of this study is to assess the incidence and the prognostic value of conventional peritoneal cytology in biliary tract cancers.
A total of consecutive 41 patients with biliary cancers (17 bile duct, 20 gallbladder, 4 ampulla of Vater) underwent surgery between July 2003 and July 2005. Peritoneal cytology was performed in these patients at the beginning of laparotomy. On opening the abdomen, 100mL of normal saline were instilled into the subhepatic space and retrieved. Cytologic analysis was performed using the Papanicolau technique.
The overall incidence of positive cytology findings was 9.8% (4/41). When analyzed by disease factors or stage, the prevalence of positive cytology was 0% in T1/T2, 6% in T3, 38% in T4 (p=0.03), 0% in N0, 25% in N1 (p=.03), 3% in M0, 27% in M1 (p=0.02), 0% in Stage I/II and 27% in Stage III/IV cases (p<0.01), respectively. Although survival was worse in patients with positive peritoneal cytology, when adjusting TNM stage the positive peritoneal cytology did not have significant prognostic value.
Peritoneal cytology associates positively with advanced disease but does not increase prognostic information in biliary tract cancers.
背景/目的：腹膜细胞学检查可为腹部癌症提供有价值的预后信息。本研究旨在评估常规腹膜细胞学检查在胆管癌中的发生率及预后价值。
2003年7月至2005年7月期间，共有41例连续性胆管癌患者（17例胆管癌、20例胆囊癌、4例 Vater壶腹癌）接受了手术。这些患者在剖腹手术开始时进行了腹膜细胞学检查。打开腹腔后，向肝下间隙注入100mL生理盐水并回收。采用巴氏技术进行细胞学分析。
细胞学检查阳性结果的总体发生率为9.8%（4/41）。按疾病因素或分期分析时，T1/T2期细胞学检查阳性率为0%，T3期为6%，T4期为38%（p = 0.03）；N0期为0%，N1期为25%（p = 0.03）；M0期为3%，M1期为27%（p = 0.02）；I/II期为0%，III/IV期为27%（p < 0.01）。尽管腹膜细胞学检查阳性的患者生存率较差，但在调整TNM分期后，阳性腹膜细胞学检查并无显著的预后价值。
腹膜细胞学检查与晚期疾病呈正相关，但在胆管癌中并未增加预后信息。
