Mathew G, Watson D I, Rofe A M, Ellis T, Jamieson G G
Royal Adelaide Centre for Endoscopic Surgery, Royal Adelaide Hospital, Australia.
Aust N Z J Surg. 1997 May;67(5):289-92. doi: 10.1111/j.1445-2197.1997.tb01965.x.
An investigation of the effect of laparoscopy and CO2 pneumoperitoneum on the pattern of tumour implantation and growth in the peritoneal cavity was carried out.
A suspension of viable adenocarcinoma cells was introduced into the left upper quadrant of the peritoneal cavity of 36 syngeneic immune-competent rats at laparotomy, laparoscopy with CO2 insufflation, and gasless laparoscopy (12 rats in each group). Six days later the peritoneal cavity and surgical wounds were examined for macroscopic evidence of implanted tumour. The abdominal cavity was divided into sectors and macroscopic tumour implantation was determined for each sector and wound. This was confirmed by histological examination.
While tumour implantation occurred in the vicinity of the tumour suspension introduction site in the laparotomy and gasless laparoscopy groups, implantation occurred throughout the peritoneal cavity, including areas remote to the introduction site, in the laparoscopy with CO2 insufflation group. Tumour growth was more likely in the port wounds of rats undergoing laparoscopy with insufflation than without.
In this model, CO2 insufflation during laparoscopy resulted in widespread tumour dissemination and implantation, when compared to laparotomy and gasless laparoscopy, supporting the postulate that wound metastasis and tumour spread may be more likely following laparoscopic cancer surgery in humans when CO2 insufflation is used.
开展了一项关于腹腔镜检查及二氧化碳气腹对肿瘤在腹腔内种植和生长模式影响的研究。
在剖腹手术、二氧化碳充气腹腔镜检查和免气腹腹腔镜检查时（每组12只大鼠），将存活的腺癌细胞悬液注入36只同基因有免疫活性大鼠的腹腔左上象限。六天后，检查腹腔和手术伤口，寻找植入肿瘤的宏观证据。将腹腔分为多个区域，确定每个区域和伤口的宏观肿瘤植入情况。通过组织学检查加以证实。
在剖腹手术组和免气腹腹腔镜检查组中，肿瘤种植发生在肿瘤悬液注入部位附近，而在二氧化碳充气腹腔镜检查组中，种植发生在整个腹腔，包括远离注入部位的区域。与未进行充气的腹腔镜检查相比，进行充气腹腔镜检查的大鼠的端口伤口更易发生肿瘤生长。
在此模型中，与剖腹手术和免气腹腹腔镜检查相比，腹腔镜检查期间的二氧化碳充气导致肿瘤广泛播散和种植，这支持了如下假设：在人类进行腹腔镜癌症手术时，使用二氧化碳充气可能更易发生伤口转移和肿瘤播散。
