Shen Ming-Yin, Huang I-Ping, Chen Wei-Shone, Chang Jui-Ting, Lin Jen-Kou
Division of Colon and Rectal Surgery, Department of Surgery, Veterans General Hospital,Taipei, Taiwan.
Hepatogastroenterology. 2008 May-Jun;55(84):947-51.
BACKGROUND/AIMS: The employment of laparoscopy in the treatment of locally advanced colorectal cancer is still questioned by many surgeons, mainly due to the fear of spreading tumors by the laparoscopic procedure. However, it is still unknown whether laparoscopy is actually associated with increased tumor dissemination, especially for those with tumor invasion through the serosa. The main purpose of this study is to investigate the effect of pneumoperitoneum on the intra-abdominal tumor growth and spreading of colon cancer cells by an animal study of murine model.
Under anesthesia, 10(6) tumor cells (CT26) were inoculated into the lower abdominal cavity of BALB/c mice by a mini-laparotomy. The mice were randomized to undergo pneumoperitoneum with CO2 (n=10), helium (n=10), or to act as controls (n=10). Pneumoperitoneum was established over 20 min at a pressure of 10cm H2O. The distribution pattern and the weight of peritoneal tumor growth of each mouse were recorded and analyzed at 15 days after surgery.
The mean ratios of the tumor mass over the total body weight of the mice were 0.77+/-1.13% (control group), 4.30+/-0.86% (CO2 pneumoperitoneum), and 2.17+/-0.88% (helium pneumoperi-toneum). The mean tumor weight ratio (3.23+/-1.38%) of the pneumoperitoneal group was 4 times larger than that of the control group (p<0.001). Regarding the use of different insufflation gases over tumor growth, CO2 accelerates tumor growth more significantly than helium (p<0.001). Intraabdominal distribution (p=0.047) and diaphragm spreading (p<0.001) were significantly greater in the pneumoperitoneum group than the control group.
The results of this animal study imply that presence of a pneumoperitoneum enhances the implantation and growth of free intraperitoneal malignant colon cancer cells in this in vivo mouse model. The results of the current study suggest that insufflation during pneumoperitoneum may play an important role in the development of peritoneal dissemination when there are free tumor cells in the intra-abdominal cavity, and the effect of using CO2 might be greater than that of using helium.
背景/目的：腹腔镜在局部晚期结直肠癌治疗中的应用仍受到许多外科医生的质疑，主要是因为担心腹腔镜手术会导致肿瘤播散。然而，腹腔镜是否真的会增加肿瘤播散，尤其是对于肿瘤侵犯浆膜的患者，目前仍不清楚。本研究的主要目的是通过小鼠模型的动物研究，探讨气腹对腹腔内肿瘤生长及结肠癌细胞播散的影响。
在麻醉状态下，通过小切口剖腹术将10(6)个肿瘤细胞（CT26）接种到BALB/c小鼠的下腹腔。将小鼠随机分为接受二氧化碳气腹组（n=10）、氦气气腹组（n=10）或作为对照组（n=10）。在10cm H2O的压力下于20分钟内建立气腹。术后15天记录并分析每只小鼠腹腔肿瘤生长的分布模式和重量。
小鼠肿瘤质量占总体重的平均比例在对照组为0.77±1.13%，二氧化碳气腹组为4.30±0.86%，氦气气腹组为2.17±0.88%。气腹组的平均肿瘤重量比例（3.23±1.38%）是对照组（p<0.001）的4倍。关于不同充气气体对肿瘤生长的影响，二氧化碳比氦气更显著地加速肿瘤生长（p<0.001）。气腹组的腹腔内分布（p=0.047）和膈肌播散（p<0.001）明显大于对照组。
本动物研究结果表明，在这种体内小鼠模型中，气腹的存在会增强游离腹腔内恶性结肠癌细胞的种植和生长。本研究结果提示，当腹腔内存在游离肿瘤细胞时，气腹过程中的充气可能在腹膜播散的发生中起重要作用，且使用二氧化碳的影响可能大于使用氦气。
