Mariani P P, van Pelt J F, Ectors N, Topal B, D'Hoore A, Penninckx F
Departments of Abdominal Surgery, Pathology and Liver and Pancreatic Diseases, Laboratory of Hepatology, University Clinic Gasthuisberg, Leuven, Belgium.
Br J Surg. 2002 Dec;89(12):1540-4. doi: 10.1046/j.1365-2168.2002.02224.x.
Rectal irrigation with a cytotoxic agent does not kill viable intraluminal cancer cells proximal to the primary tumour. To prevent implantation of these cells at the time of restorative proctectomy, the feasibility of retrograde whole-colon irrigation just before surgery was explored.
The cytotoxic efficacy of different combinations of povidone-iodine (PVPI) and Gastrografin was tested with the trypan blue exclusion test on a human colon carcinoma cell line (SW620) in vitro. Subsequently, a retrograde whole-colon lavage with PVPI 5 per cent and Gastrografin 12 per cent was performed in 14 euthyroid, non-allergic patients with colorectal cancer using a colostomy irrigation set. Thyroid function and mucosal damage were assessed.
It took 2 min and approximately 1 litre of infused solution to reach the caecum in all patients. The solution was 100 per cent tumoricidal in vitro and remained so after colonic irrigation. Total serum tri-iodothyronine (T3) levels decreased and those of reverse T3 increased, but normalized after 1 week. Superficial epithelial desquamation was observed shortly after irrigation; however, complete restoration occurred within 7 days.
A rectal washout can easily be extended to a retrograde irrigation of the whole colon in elective colorectal cancer surgery. This may help to prevent anastomotic and local recurrence due to implantation of viable exfoliated tumour cells.
用细胞毒性药物进行直肠灌洗并不能杀死原发肿瘤近端腔内的存活癌细胞。为了在保留肛门的直肠切除术中防止这些细胞种植，探讨了术前逆行全结肠灌洗的可行性。
在体外用人结肠癌细胞系（SW620）通过台盼蓝排斥试验测试聚维酮碘（PVPI）和泛影葡胺不同组合的细胞毒性作用。随后，使用结肠造口灌洗装置对14例甲状腺功能正常、无过敏反应的结直肠癌患者进行5%PVPI和12%泛影葡胺的逆行全结肠灌洗。评估甲状腺功能和黏膜损伤情况。
所有患者均在2分钟内且输注约1升溶液后溶液到达盲肠。该溶液在体外具有100%的杀肿瘤细胞作用，结肠灌洗后仍保持如此。血清总三碘甲状腺原氨酸（T3）水平降低，反式T3水平升高，但1周后恢复正常。灌洗后不久观察到浅表上皮脱屑；然而，7天内完全恢复。
在择期结直肠癌手术中，直肠冲洗可轻易扩展为全结肠逆行灌洗。这可能有助于预防因存活的脱落肿瘤细胞种植导致的吻合口和局部复发。
