Tsivian Alexander, Sidi A Ami
Department of Urologic Surgery, Edith Wolfson Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Holon, Israel.
J Urol. 2003 Apr;169(4):1213-8. doi: 10.1097/01.ju.0000035910.75480.4b.
Laparoscopic surgery is rapidly gaining widespread acceptance among urologists, including extensive application in malignant conditions. However, untoward occurrences of port site metastases have not eluded to urological applications. This up-to-date review on port site metastases in urology delineates possible contributing factors and describes techniques to prevent it.
We comprehensively reviewed published experimental and clinical studies with special emphasis on the incidence, pathophysiology and prevention of port site metastases.
Nine cases of port site metastases after urological laparoscopy have been described in clinical and experimental studies. Etiological factors include natural malignant disease behavior, host immune status, local wound factors, laparoscopy related factors such as aerosolization of tumor cells (the use of gas, type of gas, insufflation and desufflation, and pneumoperitoneum) and sufficient technical experience of the surgeons and operating team (adequate laparoscopic equipment, skill, minimal handling of the tumor, surgical manipulation and wound contamination during instruments change, organ morcellation and specimen removal).
Port site metastases is a multifactorial phenomenon with an as yet undetermined incidence. The problem is influenced to some extent by surgeon and operating team experience and, therefore, it could be partially prevented. The suggested preventive steps are avoiding laparoscopic surgery when there are ascites, trocar fixation to prevent dislodgment, avoiding gas leakage along and around the trocar, sufficient technical readiness of the operating team (adequate laparoscopic equipment and technique, minimal handling and avoiding tumor boundary violation of the tumor), using a bag for specimen removal, placing drainage when needed before desufflation, povidone-iodine irrigation of instruments, trocars and port site wounds, and suturing 10 mm. and larger trocar wounds.
腹腔镜手术在泌尿外科医生中迅速得到广泛认可，包括在恶性疾病中的广泛应用。然而，端口部位转移的不良事件在泌尿外科应用中也时有发生。这篇关于泌尿外科端口部位转移的最新综述阐述了可能的促成因素，并描述了预防方法。
我们全面回顾了已发表的实验和临床研究，特别强调了端口部位转移的发生率、病理生理学和预防。
临床和实验研究中描述了9例泌尿外科腹腔镜术后端口部位转移的病例。病因包括自然恶性疾病行为、宿主免疫状态、局部伤口因素、与腹腔镜相关的因素，如肿瘤细胞的雾化（气体的使用、气体类型、充气和放气以及气腹），以及外科医生和手术团队的充分技术经验（足够的腹腔镜设备、技能、对肿瘤的最小操作、器械更换期间的手术操作和伤口污染、器官切碎和标本取出）。
端口部位转移是一种多因素现象，其发生率尚未确定。这个问题在一定程度上受外科医生和手术团队经验的影响，因此可以部分预防。建议的预防措施包括：有腹水时避免进行腹腔镜手术；套管针固定以防止移位；避免套管针周围及沿其漏气；手术团队具备充分的技术准备（足够的腹腔镜设备和技术、对肿瘤的最小操作并避免侵犯肿瘤边界）；使用袋子取出标本；放气前必要时放置引流；用聚维酮碘冲洗器械、套管针和端口部位伤口；缝合10毫米及更大的套管针伤口。
