Okumura M, Ohshima S, Kotake Y, Morino H, Kikui M, Yasumitsu T
Department of Surgery, Osaka Prefectural Habikino Hospital, Japan.
Ann Thorac Surg. 1991 Apr;51(4):599-604. doi: 10.1016/0003-4975(91)90318-k.
Cytology of intraoperative pleural lavage was examined in 164 lung cancer patients who underwent pulmonary resections. None of the patients had any pleural effusion or dissemination. Cytology was performed three times: (1) at thoracotomy, (2) immediately after resection, and (3) after washing the pleural cavity with 5,000 mL of physiological saline solution just before closure of the chest wall. Twenty-three patients (14%) had more than one positive cytological finding. The frequency of positive cytological findings was significantly correlated with pathological T classification, pleural status, and pathological stage. The positive lavage group had a significantly higher recurrence rate than the negative lavage group in patients with stage I or stage II cancer. Four patients in the positive lavage group (17.4%) had recurrence in pleura or pericardium whereas only 1 patient in the negative lavage group (0.7%) had a recurrence in pericardium. The positive cytological finding of pleural lavage has more important meaning as a prognostic factor in stage I and stage II and indicates a greater possibility of recurrence in pleura or pericardium, but further examinations to evaluate the viability of detected malignant cells are required so that the positive cytological findings of pleural lavage can be regarded as subclinical pleural dissemination.
对164例行肺切除术的肺癌患者的术中胸腔灌洗细胞学进行了检查。所有患者均无胸腔积液或播散。细胞学检查进行了三次：（1）开胸时，（2）切除后立即进行，（3）在关闭胸壁前用5000 mL生理盐水冲洗胸腔后进行。23例患者（14%）有不止一项阳性细胞学检查结果。阳性细胞学检查结果的频率与病理T分类、胸膜状态和病理分期显著相关。在I期或II期癌症患者中，阳性灌洗组的复发率明显高于阴性灌洗组。阳性灌洗组中有4例患者（17.4%）在胸膜或心包复发，而阴性灌洗组中只有1例患者（0.7%）在心包复发。胸腔灌洗的阳性细胞学检查结果作为I期和II期的预后因素具有更重要的意义，表明胸膜或心包复发的可能性更大，但需要进一步检查以评估检测到的恶性细胞的活力，以便将胸腔灌洗的阳性细胞学检查结果视为亚临床胸膜播散。
