Köster S, Melchert F, Volz J
Universitäts-Frauenklinik Mannheim, Fakultät für Klinische Medizin, Universität Heidelberg.
Geburtshilfe Frauenheilkd. 1996 Sep;56(9):458-61. doi: 10.1055/s-2007-1022287.
Clinical observations during recent years describe the increased occurrence of rapid intraperitoneal metastases and an impairment of prognosis if a malignant tumour was operated laparoscopically. It is not known whether the observed induction of intraabdominal metastases after laparoscopic surgery in the result of an inadequate surgical procedure with spillage of tumour cells into the abdominal cavity or whether pneumoperitoneum-induced changes of the peritoneal milieu promote tumour growth. An animal model was established to examine the effect of a CO2-pneumoperitoneum on the intraperitoneal growth of tumour cells. Six week old nude mice were divided into 4 groups of 15 animals each. A CO2-pneumoperitoneum was induced by a micro-hysteroflator with an intraperitoneal pressure of 6 mmHg for 90 minutes in groups 2 and 4. Two different tumour cell lines, suspended in 2 ml of Ringer's solution for homogeneous spread of the cells, were injected i.p.. The control groups 1 and 3 received the tumour cells without pneumoperitoneum induction of a CO2-pneumoperitoneum resulted in an increasing seeding rate of tumour cells and provoked a significant increase in the number and size of intraabdominal metastases. Laparoscopic surgery of malignancies is therefore contraindicated.
近年来的临床观察表明，快速腹腔内转移的发生率有所增加，并且如果对恶性肿瘤进行腹腔镜手术，预后会受到损害。目前尚不清楚腹腔镜手术后观察到的腹腔内转移的诱发是由于手术操作不当导致肿瘤细胞溢出到腹腔，还是气腹引起的腹膜环境变化促进了肿瘤生长。建立了一个动物模型来研究二氧化碳气腹对肿瘤细胞腹腔内生长的影响。六周大的裸鼠被分成4组，每组15只动物。在第2组和第4组中，用微型宫腔镜扩张器诱导二氧化碳气腹，腹腔内压力为6 mmHg，持续90分钟。将两种不同的肿瘤细胞系悬浮在2 ml林格氏溶液中以使细胞均匀扩散，然后腹腔注射。对照组1和3在未诱导气腹的情况下接受肿瘤细胞。二氧化碳气腹导致肿瘤细胞的种植率增加，并使腹腔内转移的数量和大小显著增加。因此，恶性肿瘤的腹腔镜手术是禁忌的。
