Gahlen J, Stern J, Laubach H H, Pietschmann M, Herfarth C
Department of Surgery, University of Heidelberg, Germany.
Surgery. 1999 Sep;126(3):469-73.
Lymph node metastases and peritoneal carcinosis, occurring as a result of gastrointestinal cancer, reduce the likelihood that conventional therapy will be adequate to remove the cancer. Although diagnostic techniques have greatly improved, it is not always possible to diagnose the entire extent of the metastases. Often, peritoneal micrometastases are not visible and may be missed during laparoscopic or open surgery.
Peritoneal carcinosis was induced in WAG-Rij rats (n = 6), by laparoscopically implanting 1,2-dimethylhydrazine-induced colon carcinoma tumor cells (CC531, 5 x 10(5)) at multiple sites within the peritoneal cavity. After 12 days of tumor growth, the animals were given delta-aminolevulinic acid (ALA) (5 mL, 3% solution in 0.17 mol/L NaHCO3) by peritoneal lavage. The tumors were visualized laparoscopically using both white and blue light (D-light, Karl Storz, Tuttlingen, Germany). Fluorescence was detected by using a modified CCD camera and a special observation filter incorporated into the laparoscope.
Peritoneal carcinoma foci ranging in size from 0.05 to 2.0 cm were clearly visible laparoscopically with conventional white light (n = 142). After blue light excitation, all 142 tumors identified with white light were also identified by fluorescence. There were an additional 30 tumors that could only be identified by blue light-induced fluorescence and were histologically confirmed to be derived from colon carcinoma tumor cells.
Peritoneal colonic carcinoma foci were detected laparoscopically after intraperitoneal lavage with delta-aminolevulinic acid (ALA) and excitation with blue light. These experiments demonstrate that fluorescence laparoscopy is an important technique for the staging of gastrointestinal cancer, including colorectal cancer, because of the enhanced ability to detect small cancerous foci.
胃肠道癌导致的淋巴结转移和腹膜癌会降低传统疗法充分清除癌症的可能性。尽管诊断技术有了很大改进，但并不总是能够诊断出转移灶的全部范围。通常，腹膜微转移灶不可见，在腹腔镜手术或开放手术中可能会被遗漏。
通过腹腔镜在WAG-Rij大鼠（n = 6）的腹腔内多个部位植入1,2-二甲基肼诱导的结肠癌肿瘤细胞（CC531，5×10⁵），诱导产生腹膜癌。肿瘤生长12天后，通过腹腔灌洗给动物注射δ-氨基乙酰丙酸（ALA）（5 mL，0.17 mol/L NaHCO₃中的3%溶液）。使用白光和蓝光（D-light，卡尔·史托斯，德国图特林根）通过腹腔镜观察肿瘤。使用改良的电荷耦合器件（CCD）相机和集成在腹腔镜中的特殊观察滤光片检测荧光。
用传统白光在腹腔镜下可清晰看到大小从0.05到2.0 cm不等的腹膜癌灶（n = 142）。蓝光激发后，所有用白光识别出的142个肿瘤也通过荧光被识别出来。另外还有30个肿瘤只能通过蓝光诱导的荧光识别，经组织学证实源自结肠癌细胞。
腹腔内灌洗δ-氨基乙酰丙酸（ALA）并用蓝光激发后，通过腹腔镜检测到了腹膜结肠癌灶。这些实验表明，荧光腹腔镜检查是胃肠道癌（包括结直肠癌）分期的一项重要技术，因为它具有更强的检测小癌灶的能力。
