Bouvy N D, Marquet R L, Jeekel H, Bonjer H J
Department of Surgery, University Hospital, Dijkzigt, Rotterdam, The Netherlands.
Ann Surg. 1996 Dec;224(6):694-700; discussion 700-1. doi: 10.1097/00000658-199612000-00005.
A tumor model in the rat was used to study peritoneal tumor growth and abdominal wall metastases after carbon dioxide (CO2) pneumoperitoneum, gasless laparoscopy, and laparotomy.
The role of laparoscopic resection of cancer is under debate. Insufflation of the peritoneal cavity with CO2 is believed to be a causative factor in the development of abdominal wall metastases after laparoscopic resection of malignant tumors.
In the solid tumor model, a lump of 350-mg CC-531 tumor cells was placed intraperitoneally in rats having CO2 pneumoperitoneum (n = 8), gasless laparoscopy (n = 8), or conventional laparotomy (n = 8). After 20 minutes, the solid tumor was removed through a laparoscopic port or through the laparotomy. In the cell seeding model, 5 x 10(5) CC-531 cells were injected intraperitoneally before CO2 pneumoperitoneum (n = 12), gasless laparoscopy (n = 12), or laparotomy (n = 12). All operative procedures lasted 20 minutes. After 6 weeks, in the solid tumor model and after 4 weeks in the cell seeding model, tumor growth was scored semiquantitatively. All results were analyzed using the analysis of variance.
In the solid tumor model, peritoneal tumor growth in the laparotomy group was greater than in the CO2 pneumoperitoneum group (p < 0.01). Peritoneal tumor growth in the CO2 group was greater than in the gasless group (p < 0.01). The size of abdominal wall metastases was greater at the port site of extraction of the tumor than at the other port sites (p < 0.001). In the cell seeding model, peritoneal tumor growth was greater after laparotomy in comparison to CO2 pneumoperitoneum (p < 0.02). Peritoneal tumor growth in the CO2 group was greater than in the gasless group (p < 0.01). The port site metastases in the CO2 group were greater than in the gasless group (p < 0.01).
The following conclusions can be made: 1) that direct contact between solid tumor and the port site enhances local tumor growth, 2) that laparoscopy is associated with less intraperitoneal tumor growth than laparotomy, and 3) that insufflation of CO2 promotes tumor growth at the peritoneum and is associated with greater abdominal wall metastases than gasless laparoscopy.
使用大鼠肿瘤模型研究二氧化碳（CO₂）气腹、免气腹腹腔镜检查和开腹手术后腹膜肿瘤生长及腹壁转移情况。
腹腔镜下癌症切除术的作用仍存在争议。二氧化碳气腹被认为是腹腔镜下恶性肿瘤切除术后腹壁转移发生的一个致病因素。
在实体瘤模型中，将350毫克CC - 531肿瘤细胞团块经腹腔注入接受二氧化碳气腹（n = 8）、免气腹腹腔镜检查（n = 8）或传统开腹手术（n = 8）的大鼠体内。20分钟后，通过腹腔镜端口或开腹手术取出实体瘤。在细胞接种模型中，在二氧化碳气腹（n = 12）、免气腹腹腔镜检查（n = 12）或开腹手术（n = 12）前经腹腔注射5×10⁵个CC - 531细胞。所有手术操作持续20分钟。6周后，在实体瘤模型中以及4周后在细胞接种模型中，对肿瘤生长进行半定量评分。所有结果采用方差分析进行分析。
在实体瘤模型中，开腹手术组的腹膜肿瘤生长大于二氧化碳气腹组（p < 0.01）。二氧化碳气腹组的腹膜肿瘤生长大于免气腹组（p < 0.01）。肿瘤取出端口部位的腹壁转移瘤大小大于其他端口部位（p < 0.001）。在细胞接种模型中，开腹手术后的腹膜肿瘤生长大于二氧化碳气腹组（p < 0.02）。二氧化碳气腹组的腹膜肿瘤生长大于免气腹组（p < 0.01）。二氧化碳气腹组的端口部位转移瘤大于免气腹组（p < 0.01）。
可得出以下结论：1）实体瘤与端口部位的直接接触会促进局部肿瘤生长；2）腹腔镜检查与开腹手术相比，腹腔内肿瘤生长较少；3）二氧化碳气腹会促进腹膜肿瘤生长，且与免气腹腹腔镜检查相比，腹壁转移瘤更多。
