Zayyan K S, Christie-Brown J S, Van Noorden S, Yiu C-Y, Sellu D P, Mathie R T
Division of Surgery, Anaesthetics and Intensive Care, Imperial College School of Medicine, Hammersmith Hospital, London, UK.
Surg Endosc. 2003 Feb;17(2):273-7. doi: 10.1007/s00464-002-8824-8. Epub 2002 Oct 29.
The role of carbon dioxide (CO2) in the pathogenesis of tumor recurrence after laparoscopy remains controversial. Using a new rat model, we studied the effect of different CO2 flow rates on the dispersal of free cancer cells.
A novel model of desufflation without trocar was developed, and 55 Fischer rats were randomized into three flow groups: group A (rapid, 0.67 l/min; n = 20), group B (slow, 0.44 l/min; n = 20), and group C (gasless, n = 15). We vented CO2 via a portless surgical valve that filtered cells. After the abdominal wall had been suspended to create space, half of the animals in each group (nonrecovery) received 7.5 x 10(6) immunolabeled rat colon cancer cells (RCC2) intraperitoneally, whereas the other half (recovery) received 7.5 x l0(6) viable RCC2 before insufflation or gasless laparoscopy. Nonrecovery animals were killed after 20 l of insufflation. Parietal peritoneal and port-site specimens were examined for RCC2 by fluorescence microscopy (FM) and flow cytometry (FC). The recovery animals were killed at 4 weeks for evidence of wound recurrence.
Nine of 10 nonrecovery animals in A had RCC2 on FM or FC, as compared with 2 animals in each of the nonrecovery groups B and C (p = 0.018, Fisher's exact test). Two of the nine animals in group A also had RCC2 in their portless valves. Two recovery (A) animals developed wound recurrence as compared with none in the other groups (p = 0.315).
In this model, rapid CO2 flow dispersed free cancer cells into the peritoneal cavity, but not into the port sites, thus supporting a role for CO2 in the intraperitoneal dispersal of free cancer cells, but not in wound recurrence.
二氧化碳（CO₂）在腹腔镜检查后肿瘤复发的发病机制中的作用仍存在争议。我们使用一种新的大鼠模型，研究了不同CO₂流速对游离癌细胞扩散的影响。
开发了一种无套管针放气的新型模型，将55只Fischer大鼠随机分为三个流速组：A组（快速，0.67升/分钟；n = 20），B组（缓慢，0.44升/分钟；n = 20），C组（无气，n = 15）。我们通过一个过滤细胞的无端口手术瓣膜排出CO₂。在腹壁被悬吊以创造空间后，每组一半的动物（未恢复组）腹腔内注射7.5×10⁶个免疫标记的大鼠结肠癌细胞（RCC2），而另一半（恢复组）在气腹或无气腹腔镜检查前接受7.5×10⁶个活的RCC2。未恢复组的动物在注入20升气体后处死。通过荧光显微镜（FM）和流式细胞术（FC）检查壁腹膜和端口部位标本中的RCC2。恢复组的动物在4周时处死，以检查伤口复发的证据。
A组10只未恢复组动物中有9只在FM或FC上检测到RCC2，而B组和C组未恢复组动物中各有2只（p = 0.018，Fisher精确检验）。A组9只动物中有2只在其无端口瓣膜中也检测到RCC2。A组有2只恢复组动物出现伤口复发，而其他组均未出现（p = 0.315）。
在该模型中，快速的CO₂流速将游离癌细胞扩散到腹腔，但未扩散到端口部位，因此支持CO₂在游离癌细胞腹腔内扩散中起作用，但在伤口复发中不起作用。
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