Hirabayashi Y, Yamaguchi K, Shiraishi N, Adachi Y, Kitamura H, Kitano S
Department of Surgery I, Oita Medical University, 1-1 Idaigaoka, Hasama-machi, Oita 879-5593, Japan.
Surg Endosc. 2002 May;16(5):864-8. doi: 10.1007/s00464-001-9121-7. Epub 2002 Feb 8.
Port-site metastasis is a critical problem in laparoscopic cancer surgery; the pathogenesis and means of prevention are still unclear. The aim of this study was to clarify by scanning electron microscopy the initial morphologic changes in the development of port-site metastasis.
Fifteen nude mice were injected with human gastric cancer (MKN 45) cells. Mice were killed on days 0, 3, and 8 (n = 5 each day) after intraperitoneal injection of 5 x 105 cancer cells and carbon dioxide (CO2) pneumoperitoneum at 4-6 mmHg for 20 min. The abdominal wall with the port sites was harvested and examined under both light and scanning electron microscopy.
Immediately after CO2 pneumoperitoneum (day 0), the abdominal peritoneum was peeled away and the muscular layer was destroyed at the port site in all mice. Several cancer cells were attached to the injured port sites. On day 3, the subperitoneal tissue and muscular layer defects were replaced by granulation tissue, and several cancer cells were observed in the subperitoneal tissue. On day 8, a small nodule was macroscopically visible at the port site; it was completely covered by mesothelial cells and consisted of numerous cancer cells.
Free cancer cells appear to attach to the injured port sites immediately after CO2 pneumoperitoneum, and these are associated with the development of port-site metastasis after laparoscopic cancer surgery.
端口部位转移是腹腔镜癌症手术中的一个关键问题；其发病机制和预防方法仍不清楚。本研究的目的是通过扫描电子显微镜阐明端口部位转移发展过程中的初始形态学变化。
将15只裸鼠注射人胃癌（MKN 45）细胞。在腹腔注射5×10⁵个癌细胞并在4 - 6 mmHg下进行20分钟二氧化碳（CO₂）气腹后，于第0天、第3天和第8天处死小鼠（每天n = 5）。采集带有端口部位的腹壁，在光学显微镜和扫描电子显微镜下进行检查。
在二氧化碳气腹后立即（第0天），所有小鼠端口部位的腹膜被剥离，肌肉层被破坏。有几个癌细胞附着在受损的端口部位。在第3天，腹膜下组织和肌肉层缺损被肉芽组织替代，在腹膜下组织中观察到几个癌细胞。在第8天，端口部位肉眼可见一个小结节；它完全被间皮细胞覆盖，由大量癌细胞组成。
游离癌细胞似乎在二氧化碳气腹后立即附着在受损的端口部位，并且这些与腹腔镜癌症手术后端口部位转移的发生有关。
