Da Costa M L, Redmond H P, Finnegan N, Flynn M, Bouchier-Hayes D
Department of Surgery, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin.
Br J Surg. 1998 Oct;85(10):1439-42. doi: 10.1046/j.1365-2168.1998.00853.x.
Surgery depresses host tumoricidal activity and may increase tumour growth. This study compared the effects of laparoscopy with laparotomy on extraperitoneal tumour growth and immune function in a murine model.
C57BL/6 female mice aged 8-10 weeks had tumours induced in the right flank (n=45) and were randomized to undergo halothane anaesthesia only, laparoscopy or laparotomy. Flank tumour volume was assessed over 10 days. A second group of animals (n=540) were randomized to undergo the same procedures and killed at 24, 48 and 96 h. Splenocytes were harvested for natural killer (NK) cell and lymphokine activated killer (LAK) cell cytotoxicity studies.
There was a significant increase in flank tumour growth in the first 48 h after laparotomy and laparoscopy compared with controls (P < 0.01). By 96 h the difference was only significant in the laparotomy group (P< 0.01). Both NK and LAK cell cytotoxicities were suppressed significantly (P < or = 0.03) from 24 h up to 96 h following laparotomy compared with control and laparoscopy groups. There was also a significant suppression in the laparoscopy group compared with controls in the first 48 h after operation (P < or = 0.02).
Extraperitoneal tumour growth was significantly accelerated after laparotomy and correlated with significantly suppressed NK and LAK cytotoxicity for at least 4 days after operation. Laparoscopy had a shorter, less profound effect on tumour growth and immune function.
手术会抑制宿主的杀肿瘤活性，并可能促进肿瘤生长。本研究在小鼠模型中比较了腹腔镜手术与开腹手术对腹膜外肿瘤生长及免疫功能的影响。
8至10周龄的C57BL/6雌性小鼠在右侧胁腹诱导产生肿瘤（n = 45），并随机分为仅接受氟烷麻醉、接受腹腔镜手术或开腹手术三组。在10天内评估胁腹肿瘤体积。第二组动物（n = 540）随机接受相同手术，并在术后24、48和96小时处死。采集脾细胞用于自然杀伤（NK）细胞和淋巴因子激活的杀伤（LAK）细胞的细胞毒性研究。
与对照组相比，开腹手术和腹腔镜手术后的头48小时内，胁腹肿瘤生长显著增加（P < 0.01）。到96小时时，差异仅在开腹手术组显著（P < 0.01）。与对照组和腹腔镜手术组相比，开腹手术后24小时至96小时，NK和LAK细胞的细胞毒性均受到显著抑制（P ≤ 0.03）。与对照组相比，腹腔镜手术组在术后头48小时内也有显著抑制（P ≤ 0.02）。
开腹手术后腹膜外肿瘤生长显著加速，且与术后至少4天NK和LAK细胞毒性的显著抑制相关。腹腔镜手术对肿瘤生长和免疫功能的影响时间较短且程度较轻。
