Hewett P J, Texler M L, Anderson D, King G, Chatterton B E
University of Adelaide Department of Surgery, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia.
Dis Colon Rectum. 1999 Jul;42(7):868-75; discussion 875-6. doi: 10.1007/BF02237091.
A porcine model has been developed to allow the real-time imaging of radiolabeled tumor cell movement throughout the peritoneal cavity, both at rest and during carbon dioxide insufflation.
Fifteen 30-kg domestic white female pigs were used. Under anesthesia, 15 to 20 million radiolabeled human colorectal tumor cells (LIM1215) were introduced into the peritoneal cavity under laparoscopic vision into the pelvis. Radiolabeled tumor cell movement was examined by using a 25-cm-diameter, low-energy mobile gamma camera with high resolution collimator. Tumor cell movement and distribution during two hours without insufflation was examined in four pigs. Then tumor cell movement and distribution during two hours with CO2 insufflation was examined in four pigs. In a further four pigs, tumor cells were then mixed with blood and injected into the peritoneal cavity and the effect of no insufflation vs. insufflation was noted. A further three pigs were examined with manipulation of the intra-abdominal contents after injection of LIM1215 cells into the peritoneal cavity. Venting insufflating CO2 was filtered for tumor cells.
Widespread intraperitoneal distribution of tumor cells from the pelvis was identified both with CO2 insufflation of the peritoneal cavity and without insufflation. Tumor cells dispersed throughout the peritoneal cavity at a slower rate without carbon dioxide insufflation. There was a differential rate of tumor cell movement to the left upper quadrant and right upper quadrant with insufflation and without insufflation. Blood within the peritoneal cavity and an extended contact of the laparoscopic trocars with the peritoneal cavity in this setting increased contamination of the trocars and trocar sites with tumor cells. Tumor cells were identified on laparoscopic instruments in all experiments. No evidence of aerosolization of tumor cells was found.
Tumor cells move throughout the peritoneal cavity both at rest and during CO2 insufflation. The pattern of tumor cell dispersion differs with CO2 insufflation. The presence of blood and extended contact of trocars with peritoneal contents are a major factor in trocar and trocar site tumor cell contamination.
已开发出一种猪模型，用于在静息状态和二氧化碳气腹期间对放射性标记的肿瘤细胞在整个腹腔内的移动进行实时成像。
使用15头30千克的家养白色雌性猪。在麻醉状态下，在腹腔镜直视下将1500万至2000万个放射性标记的人结肠直肠肿瘤细胞（LIM1215）引入盆腔的腹腔内。使用直径25厘米、带有高分辨率准直器的低能移动γ相机检查放射性标记的肿瘤细胞移动情况。在4头猪中检查了无气腹情况下两小时内肿瘤细胞的移动和分布。然后在4头猪中检查了二氧化碳气腹情况下两小时内肿瘤细胞的移动和分布。在另外4头猪中，将肿瘤细胞与血液混合后注入腹腔，并记录无气腹与气腹的效果。在将LIM1215细胞注入腹腔后，对另外3头猪进行腹腔内容物操作检查。排出的二氧化碳气体会过滤肿瘤细胞。
无论是在腹腔进行二氧化碳气腹还是无气腹的情况下，均发现肿瘤细胞从盆腔广泛分布于腹腔内。无二氧化碳气腹时，肿瘤细胞在整个腹腔内的扩散速度较慢。在有气腹和无气腹的情况下，肿瘤细胞向左上象限和右上象限移动的速度存在差异。在此情况下，腹腔内的血液以及腹腔镜套管针与腹腔的长时间接触增加了套管针和套管针穿刺部位被肿瘤细胞污染的几率。在所有实验中，均在腹腔镜器械上发现了肿瘤细胞。未发现肿瘤细胞雾化的证据。
肿瘤细胞在静息状态和二氧化碳气腹期间均在整个腹腔内移动。肿瘤细胞的扩散模式因二氧化碳气腹而有所不同。血液的存在以及套管针与腹腔内容物的长时间接触是套管针和套管针穿刺部位被肿瘤细胞污染的主要因素。
