Brundell S M, Tucker K, Texler M, Brown B, Chatterton B, Hewett P J
Department of Surgery, University of Adelaide, The Queen Elizabeth Hospital, Woodville South, South Australia.
Surg Endosc. 2002 Oct;16(10):1413-9. doi: 10.1007/s00464-001-9112-8. Epub 2002 Jun 4.
Port-site recurrences have delayed the uptake of laparoscopic colectomy, but the etiology of these is incompletely understood. These studies were designed to investigate variables such as the size of the tumor inoculum and the volume and pressure of the insufflated gas during operative laparoscopy that might affect the deposition of these cells in relation to trocars and port sites.
Radiolabeled human colon cancer cells were injected into the peritoneal cavity of pigs. Three trocars were inserted, and the abdomen was insufflated with carbon dioxide. The movement of cells within the abdomen was traced on a gamma camera. After 2 h, the trocars were removed and the port sites excised. Two studies were performed. In the first study, tumor inocula were varied from 1.5 x 10(5) to 120 x 10(5). In the second study, insufflation pressure was varied, with pressures 0, 4, 8 and 12 mmHg were studied.
When larger tumor inocula were injected, the contamination of both trocars (p = 0.005, Kendall's rank correlation) and trocar sites (p = 0.04, Kendall's rank correlation) increased. The deposition of cells on a trocar site was linked to contamination of its trocar (p = 0.03, chi-square), but the contamination of trocars did not always result in trocar-site contamination (p = 0.5, chi-square). Increased volumes of gas insufflation caused increased intraabdominal movement of tumour cells (p = 0.01, Kendall's rank correlation), although this did not lead to greater contamination of trocars or port sites (p = 0.82, Kendall's rank correlation). Decreased insufflation pressures resulted in increased contamination of trocars and port sites (p = 0.01, Kendall's rank correlation).
If clinical situations parallel this study, strategies such as increasing insufflation pressure, reducing episodes of desufflation and gas leaks, and using frequent intraabdominal lavage may help to reduce the numbers of viable tumor cells displaced to port sites during laparoscopic surgery for intraabdominal malignancy. This may reduce the rate of port-site metastases.
切口部位复发延缓了腹腔镜结肠切除术的应用，但对其病因的了解尚不全面。这些研究旨在调查诸如肿瘤接种物大小以及手术腹腔镜检查期间气腹的气体量和压力等变量，这些变量可能会影响这些细胞相对于套管针和切口部位的沉积。
将放射性标记的人结肠癌细胞注入猪的腹腔。插入三个套管针，并用二氧化碳对腹部进行气腹。在γ相机上追踪细胞在腹部内的移动。2小时后，取出套管针并切除切口部位。进行了两项研究。在第一项研究中，肿瘤接种物从1.5×10⁵变化到120×10⁵。在第二项研究中，改变气腹压力，研究了0、4、8和12 mmHg的压力。
当注入较大的肿瘤接种物时，套管针（p = 0.005，肯德尔等级相关性）和套管针部位（p = 0.04，肯德尔等级相关性）的污染均增加。细胞在套管针部位的沉积与其套管针的污染相关（p = 0.03，卡方检验），但套管针的污染并不总是导致套管针部位污染（p = 0.5，卡方检验）。增加气腹气体量导致肿瘤细胞在腹腔内的移动增加（p = 0.01，肯德尔等级相关性），尽管这并未导致套管针或切口部位的污染增加（p = 0.82，肯德尔等级相关性）。降低气腹压力导致套管针和切口部位的污染增加（p = 0.01，肯德尔等级相关性）。
如果临床情况与本研究相似，诸如增加气腹压力、减少放气和气漏次数以及频繁进行腹腔灌洗等策略，可能有助于减少腹腔镜手术治疗腹腔恶性肿瘤期间转移至切口部位的存活肿瘤细胞数量。这可能会降低切口部位转移的发生率。
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