腹腔镜手术对大肠癌肿瘤细胞播散种植的影响

目的:比较腹腔镜结直肠癌手术和开腹结直肠癌手术对结直肠癌肿瘤细胞的播散种植的影响.方法:收集2001-2003年腹腔镜结直肠癌手术36例和开腹结直肠癌手术45例,收集两组手术术前,术后腹腔冲洗液100ml,在腹腔镜组术后用100ml生理盐水冲洗腹腔镜手术特有器械,在腹腔镜组,气腹后通过套管针侧孔引出CO2气体,经过100ml生理盐水的滤过后,收集过滤液,所有液体经离心后,涂片固定染色,观察肿瘤细胞.结果:腹腔镜气腹CO2气体滤过液中未观察到肿瘤细胞,腹腔镜器械冲洗液发现1例阳性,阳性率为2.8%.两组术前腹腔冲洗液中肿瘤细胞的阳性率均为33.3%,术后肿瘤细胞阳性率分别为8.3%和11.1%.在两种手术方式中无明显差别.结论:CO2气腹不会引起肿瘤细胞的播散.腹腔镜术中器械污染是引起切口转移的主要原因之一.腹腔镜手术不增加肿瘤细胞播散种植的机会.

Effect of colorectal laparoscopic surgery on tumor cell dissemination and seeding

Objective:To compare the effect of colorectal laparoscopic surgery and conventional surgery on tumor cell dissemination and seeding.Methods:From 2001 to 2003, intraoperative peritoneal lavage cytology was performed in 36 patients with colorectal cancer during colorectal laparoscopic surgery and in 45 patients with conventional surgery. Cytology was examined twice, i.e. immediately after opening the peritoneal cavity and just before closing the abdomen. 100ml saline was poured into the peritoneal cavity and was retrieved by suction after irrigation. Laparoscopic instruments were lavaged after surgery by 100ml saline. CO 2 was derivated through the side orifice of the trocar after pneumoperitoneum during laparoscopic coloctomy and filtered through 100 ml saline. Cytologic examination of the filtrate was performed after filtration process, smear, fixation and staining.Results:Malignant cells were not detected in CO 2 filtrated gas. The incidence of positive cytology in the lavage fluid of instruments during laparoscopic surgery was 2.8 percent. The incidence of positive cytology in the prelavage during laparoscopic surgery was 33.33 percent, and that in the postlavage was 8.3 percent. The incidence of positive cytology in the prelavage during conventional surgery was 33.3 percent, and that in the postlavage was 11.1 percent.Conclusion:CO 2 pneumoperitoneum does not affect tumor cell dissemination and seeding during colorectal laparoscopic surgery. Frequent contact between wounds and contaminated laparoscopic instruments were proposed to explain the phenomenon of cancer recurrence at trocar insertion.Laparoscopic techniques in colorectal cancer surgery does not increase risk of intraperitoneal cancer cell dissemination,compared with conventional techniques.