Hoffstetter W, Ortega A, Chiang M, Paik P, Beart R W
Division of Colorectal Surgery, University of Southern California, Los Angeles, 90033, USA.
J Laparoendosc Adv Surg Tech A. 2001 Feb;11(1):9-12. doi: 10.1089/10926420150502878.
Reports of metastatic spread of colon and rectal cancer to port sites after laparoscopic resection of potentially curable lesions has raised doubt regarding the efficacy and safety of laparoscopic technology in cancer surgery. Experimental study in animals has led us to believe that the mode of spread of these metastases is via the direct route. We hypothesized, therefore, that we could decrease the rate of trocar-site recurrences by treating the individual port sites with a topical tumoricidal agent.
Male BD-IX rats weighing 240 to 360 g were injected with syngeneic colon cancer to simulate free intraperitoneal cancer spread to trocar sites. All rats were subjected to a sham laparoscopic operation after 2 x 10(5) viable cancer cells had been injected into their peritoneal cavities. Five-millimeter trocars were inserted into each rat after abdominal insufflation to 10 mm Hg. Pneumoperitoneum was maintained for 10 minutes before the trocars were removed simultaneously. Trocar sites were then subjected to one of three treatments, with each animal receiving a maximum of two different treatments. Sites were treated with 70% ethanol (N = 42), povidine/ iodine (N = 40), or no topical treatment (N = 46). Three weeks later, the animals were euthanized and autopsied. Subcutaneous tumors at trocar sites or tumors with >50% volume within the wound were considered implants.
Control sites revealed a metastasis rate of 41% (19/46). The tumor implant rate was 36% (15/42) at alcohol-treated sites and 20% (8/40) at sites treated with povidone-iodine (P < 0.05).
Topical administration of povidone-iodine to trocar wounds after laparoscopic surgery can significantly reduce the incidence of port-site metastasis in a syngeneic animal model of colon cancer.
关于结肠癌和直肠癌在腹腔镜切除潜在可治愈性病变后转移至穿刺部位的报道，引发了人们对腹腔镜技术在癌症手术中疗效和安全性的质疑。动物实验研究使我们相信，这些转移瘤的传播方式是直接途径。因此，我们推测，通过局部应用肿瘤杀伤剂处理各个穿刺部位，可以降低穿刺部位复发率。
选用体重240至360克的雄性BD-IX大鼠，注射同基因结肠癌细胞，以模拟腹腔内癌细胞向穿刺部位的自由扩散。在向所有大鼠腹腔内注射2×10⁵个活癌细胞后，进行假腹腔镜手术。腹部充气至10毫米汞柱后，将5毫米的穿刺器插入每只大鼠体内。气腹维持10分钟后，同时拔出穿刺器。然后，对穿刺部位进行三种处理之一，每只动物最多接受两种不同处理。处理方式为用70%乙醇（N = 42）、聚维酮碘（N = 40）处理，或不进行局部处理（N = 46）。三周后，对动物实施安乐死并进行尸检。穿刺部位的皮下肿瘤或伤口内体积超过50%的肿瘤被视为种植瘤。
对照组穿刺部位转移率为41%（19/46）。乙醇处理部位的肿瘤种植率为36%（15/42），聚维酮碘处理部位的肿瘤种植率为20%（8/40）（P < 0.05）。
在同基因结肠癌动物模型中，腹腔镜手术后对穿刺伤口局部应用聚维酮碘可显著降低穿刺部位转移的发生率。
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