Fletcher J N, Mew D, DesCôteaux J G
University of Calgary, Alberta, Canada.
Am J Surg. 1999 Jul;178(1):57-9. doi: 10.1016/s0002-9610(99)00109-9.
The observed occurrence of port site recurrence in laparoscopic surgery for malignant disease has stimulated interest in the dissemination of tumor cells during surgery. Study of electrocautery smoke has revealed the presence of large particles and viable viruses. The purpose of this study was to determine if viable malignant cells are present in suspension within the electrocautery plume.
Pellets of B16-F0 mouse melanoma cells were cauterized and the plume collected into culture medium. In part 1 of this study, the trypan blue assay was used to assess cell viability immediately after collection and 7 days later. A cautery current of 30 W was applied for 5 minutes. In part 2, the tetrazolium (MTT) viability assay was used to assess cell viability after cauterization of tumor pellets at 10, 20, and 30 W for 5 seconds.
Although intact melanoma cells were identified with the trypan blue assay immediately after plume collection, no viable cells were seen at 7 days using this assay. In part 2, viable melanoma cells were present in the culture wells at 7 days. Lower fulguration currents appeared to yield higher cell counts: 2,250 cells/well at 10 W, 2,100 cells/well at 20 W, and 1,800 cells/well at 30 W.
Results of this study confirm that application of electrocautery to a pellet of melanoma cells releases these cells into the plume. These cells are viable and may be grown in culture. This release of malignant cells may explain the appearance of port metastases at sites that are remote from the surgical dissection or that were never in direct contact with the tumor.
在恶性疾病的腹腔镜手术中观察到的穿刺孔复发现象引发了人们对手术过程中肿瘤细胞播散的关注。对电灼烟雾的研究发现其中存在大颗粒和活病毒。本研究的目的是确定电灼烟雾中是否存在悬浮的活恶性细胞。
对B16-F0小鼠黑色素瘤细胞团进行烧灼，并将烟雾收集到培养基中。在本研究的第1部分，使用台盼蓝试验在收集后立即以及7天后评估细胞活力。施加30W的电灼电流5分钟。在第2部分，使用四唑盐（MTT）活力试验评估在10W、20W和30W下对肿瘤细胞团烧灼5秒后的细胞活力。
尽管在收集烟雾后立即通过台盼蓝试验鉴定出完整的黑色素瘤细胞，但在7天时使用该试验未发现活细胞。在第2部分中，7天时培养孔中存在活的黑色素瘤细胞。较低的电灼电流似乎产生更高的细胞计数：10W时为2250个细胞/孔，20W时为2100个细胞/孔，30W时为1800个细胞/孔。
本研究结果证实，对黑色素瘤细胞团施加电灼会将这些细胞释放到烟雾中。这些细胞是活的，并且可以在培养中生长。恶性细胞的这种释放可能解释了在远离手术解剖部位或从未与肿瘤直接接触的部位出现穿刺孔转移的现象。
