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目的：大肠癌是最常见的恶性肿瘤之一，血行转移是大肠癌根治性手术失败的原因之一，在根治性切除肿瘤患者中，有大部分患者死于肿瘤的复发和转移，因此早期发现大肠癌微转移，对于延长患者预后指导下一步治疗具有重要意义。本研究已检测大肠癌患者外周血和引流静脉血中CEA mRNA 的表达，以探索手术操作和微转移的关系，以及引流静脉血中微转移的发生与临床病理因素的关系，探讨早期发现大肠癌血循环微转移的意义。方法：应用逆转录多聚酶链式反应（RT-PCR）法检测大肠癌患者手术前，手术后外周血及引流静脉血液中的CEA mRNA水平。结果：（1）大肠癌患者术前外周血CEA mRNA阳性率26.7 %(16/60)，引流静脉血阳性率48.3 %(29/60)，引流静脉血明显高于外周静脉血（P<0.05）。（2）大肠癌引流静脉血中CEA mRNA在肿瘤大于 5 厘米者、Dukes C期、中低分化程度、有淋巴转移者、浸及浆膜者比外周静脉血更有统计学上的意义。（3）手术前后引流静脉血 CEAmRNA阳性率具有显著差异（P<0.05），外周血CEA mRNA阳性率无显著差异。结论：大肠癌引流静脉血微转移是大肠癌肝转移的发生的早期阶段，引流静脉血CEA mRNA 的表达能更早期反映出大肠癌患者微转移的发生，引流静脉微转移发生率与肿瘤分化程度、浸润深度、TNM分期、淋巴结转移、远处转移相关，是反映大肠癌生物学行为的指标之一，手术对大肠癌血循环微转移有促进作用。

英文摘要:

Objective:Colorectal cancer is the most common malignant tumor, the blood metastasis is one of the reasons for the failure of the colorectal cancer radical surgery, most of the patients died of tumor recurrence and metastasis in the radical resection of tumor patients, therefore, the early detection of colorectal micrometastases have great significance for an extension of the prognosis of patients to guide further treatment. In order to explore the relationship between operative and micrometastases, the occurrence of venous blood micrometastases and clinicopathological factors, the significance of early detection micrometastases with colorectal cancer blood circulation, the diagnostic value of micrometastasis of colorectal cancer blood circulation, CEA mRNA levels in the peripheral blood and venous drainage blood of patients with colorectal cancer were tested.Methods:CEA mRNA levels were detected by using Reverse transcriptase polymerase chain reaction (RT-PCR) after and before surgery in the peripheral blood and venous drainage of blood with colorectal cancer.Results:(1) The patients with colorectal cancer preoperative peripheral blood CEA mRNA positive rate was 26.7%(16/60), drainage venous blood positive rate 48.3%(29/60), drainage venous blood is obviously higher than that of the peripheral venous blood (P < 0.05). (2) Venous blood of colorectal CEA mRNA in tumors was larger than 5 cm, at Dukes C period, in poorly differentiated degree, lymph node metastasis, dip and serosal more statistically significant than the peripheral venous blood. (3) Before and after surgery drainage venous blood CEA mRNA positive rate had significant difference (P < 0.05), peripheral blood CEA mRNA positive rate had no significant difference.Conclusion:The venous blood of colorectal cancer micrometastases is the early stages of colorectal liver metastases, the expression of venous drainage CEA mRNA can reflect more early colorectal cancer patients micro transfer occurs, which is one of the indicators reflect the biological behavior of colorectal, the incidence of draining veins micrometastases related to the degree of tumor differentiation, infiltration depth, TNM staging, lymph node metastasis and distant metastasis, the surgery have promoted role for colorectal cancer blood circulation micrometastasis.

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