Gahlen Johannes, Prosst Ruediger L, Pietschmann Matthias, Haase Thomas, Rheinwald Markus, Skopp Gisela, Stern Josef, Herfarth Christian
Department of Surgery, University of Heidelberg, Heidelberg, Germany.
Ann Surg. 2002 Feb;235(2):252-60. doi: 10.1097/00000658-200202000-00014.
To assess 5-aminolevulinic acid (ALA)-induced protoporphyrin IX accumulation and fluorescence in peritoneal colon carcinoma metastases and its benefits for laparoscopic fluorescence diagnosis.
Occult, macroscopically nonvisible peritoneal micrometastases can be missed in laparoscopy or open surgery. Laparoscopic fluorescence diagnosis allows detection of these lesions after intraperitoneal lavage with ALA and subsequent fluorescence induction by blue-light excitation.
A disseminated peritoneal carcinosis was induced by laparoscopic implantation of colon carcinoma cells (CC531) in the peritoneum of 55 WAG/Rij rats. After 12 days of tumor growth the animals were randomized into 11 groups with different photosensitization parameters. Peritoneal lavage was performed either with 1.5% or 3.0% ALA solution, except for one control group. Photosensitization times were 0.5, 1, 2, 4, or 8 hours. Spectrometry was performed using an optical multichannel analyser. ALA and protoporphyrin IX serum levels were measured by high-performance liquid chromatography to determine systemic load.
Protoporphyrin IX tumor accumulation and fluorescence peaked 2 to 4 hours after ALA application in both main groups, 1.5% and 3.0% ALA. Tumor detection rate was most effective in the 1.5% ALA group. Compared with conventional white-light laparoscopy alone, blue-light excitation detected 35% additional intraabdominal tumor foci.
Laparoscopic fluorescence diagnosis can increase the sensitivity and specificity of diagnostic staging laparoscopy. It allows determination of the extent of peritoneal carcinosis. Improved preoperative assessment helps to avoid unnecessary laparotomies and radical resections.
评估5-氨基乙酰丙酸（ALA）诱导的原卟啉IX在腹膜结肠癌转移灶中的蓄积及荧光情况，及其对腹腔镜荧光诊断的益处。
隐匿性、肉眼不可见的腹膜微转移灶在腹腔镜检查或开放手术中可能会被遗漏。腹腔镜荧光诊断可在腹腔内注入ALA并随后通过蓝光激发诱导荧光后检测这些病变。
通过腹腔镜将结肠癌细胞（CC531）植入55只WAG/Rij大鼠的腹膜内，诱导播散性腹膜癌。肿瘤生长12天后，将动物随机分为11组，每组具有不同的光敏参数。除一个对照组外，用1.5%或3.0%的ALA溶液进行腹腔灌洗。光敏时间为0.5、1、2、4或8小时。使用光学多通道分析仪进行光谱测定。通过高效液相色谱法测量ALA和原卟啉IX的血清水平，以确定全身负荷。
在两个主要组（1.5%和3.0%的ALA）中，原卟啉IX在肿瘤中的蓄积和荧光在应用ALA后2至4小时达到峰值。1.5%的ALA组肿瘤检测率最高。与单独的传统白光腹腔镜检查相比，蓝光激发检测到额外35%的腹腔内肿瘤病灶。
腹腔镜荧光诊断可提高诊断性分期腹腔镜检查的敏感性和特异性。它有助于确定腹膜癌的范围。改善术前评估有助于避免不必要的剖腹手术和根治性切除术。
