腹腔镜手术对荷瘤大鼠切口肿瘤转移的影响

The effect of laparoscopy on wound metastasis in a rat tumor model

目的:使用种植性大鼠肝脏肿瘤模型观察腹腔镜手术对术后切口和腹腔肿瘤种植转移的影响。方法:荷瘤W istar大鼠40只,随机分为4组(n=10):对照组、开腹组、免气腹组和CO2气腹组。术后7d处死大鼠,检查戳孔切口和腹腔内肾脏、腹膜、网膜、系膜、阴囊部脂肪,对转移肿瘤进行评估。结果:CO2气腹组和免气腹组的右上腹切口(取出标本的戳孔)肿瘤转移率显著高于其他切口(P<0.05)。CO2气腹组总的戳孔肿瘤转移率显著高于免气腹组(P<0.05)。CO2气腹组和开腹组的腹腔肿瘤转移率显著高于免气腹组(P<0.05)。结论:免气腹手术与CO2气腹腹腔镜手术、开腹手术相比,能够显著降低肿瘤种植、转移发生率;操作器械和肿瘤标本经过的戳孔,和其它戳孔相比,更易发生肿瘤的种植转移。

Objective：To investigate the effect of laparoscopy on wound and peritoneal cavity metastasis in a rat model with implanted liver tumor. Methods：Forty Wistar rats with liver implanted tumor were randomly divided into 4 groups （n = 10） ：anesthesia alone, laparotomy, gasless laparoscopy, and carbon dioxide （ CO2 ） pneumoperitoneum laparoscopy. At the 7 th day after the procedure, the rats were killed, and the port sites, kidney, omentum, mesenterium, and scrotal fat were documented for the tumor metastasis. Results： The rate of tumor metastasis was greater at the port site of specimen extraction than at the other port sites in the gasless group and carbon dioxide （ CO2 ） pneumoperitoneum group （ P 〈 0. 05 ）. The rate of tumor metastasis in the total wounds of carbon dioxide （ CO2 ） pneumoperitoneum group was greater than the gasless group （ P 〈 0. 05 ）. The rate of the tumor metastasis in the peritoneal cavity in the carbon dioxide （ CO2 ） pneumoperitoneum and laparotomy group was greater than the gasless group （ P 〈 0. 05 ）. Conclusions： The tumor metastasis rate of the gasless group is lower than the laparotomy and carbon dioxide （ CO2 ） pneumoperitoneum group. The port site of operation and specimen extraction is easier to occur tumor metastasis than the other port sites.