用于腹膜转移情况下避免穿刺孔复发的腹腔镜技术
Laparoscopy technique in the setting of peritoneal metastases to avoid port site relapse.
作者信息
Segura-Sampedro Juan José, Morales-Soriano Rafael, Pineño Flores Cristina, Craus-Miguel Andrea, Sugarbaker Paul H
机构信息
General & Digestive Surgery Department, University Hospital Son Espases, School of Medicine, University of the Balearic Islands, Health Research Institute of the Balearic Islands, Palma de Mallorca, Spain.
General & Digestive Surgery Department, University Hospital Son Espases, Health Research Institute of the Balearic Islands, Palma de Mallorca, Spain.
出版信息
Surg Oncol. 2021 Jun;37:101543. doi: 10.1016/j.suronc.2021.101543. Epub 2021 Mar 13.
BACKGROUND
Laparoscopy is indicated in many patients with abdominal and pelvic malignancy. If cancer cells are present within the peritoneal space, there is a possibility for port site metastases to develop.
METHODS
The pathophysiology for occurrence of port site metastases was reviewed. Technical modifications to reduce the incidence of these abdominal wall sites for disease progression were suggested.
RESULTS
Evacuation of all gases and all fluid from the peritoneal space through the trocars prior to their removal will reduce the contamination of the tissue surrounding the port site by intraperitoneal cancer cells. If port sites are confined to the midline, they can be removed as part of a midline abdominal incision if metastases occur. If port site metastases occur through lateral port sites, the rectus abdominus muscle may need to be widely excised to achieve negative margins.
CONCLUSION
Technical modifications of laparoscopy in patients with peritoneal metastases may reduce incidence of this iatrogenic dissemination of cancer.
背景
许多腹部和盆腔恶性肿瘤患者适合进行腹腔镜检查。如果腹膜腔内存在癌细胞，就有可能发生穿刺孔部位转移。
方法
回顾了穿刺孔部位转移发生的病理生理学。提出了技术改进措施以降低这些腹壁部位疾病进展的发生率。
结果
在拔除套管针之前，通过套管针将腹膜腔内的所有气体和液体排空，将减少腹腔癌细胞对穿刺孔部位周围组织的污染。如果穿刺孔部位局限于中线，发生转移时可作为中线腹部切口的一部分将其切除。如果穿刺孔部位转移通过侧方穿刺孔发生，可能需要广泛切除腹直肌以获得阴性切缘。
结论
对有腹膜转移的患者进行腹腔镜技术改进可能会降低这种医源性癌症播散的发生率。
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