CO2气腹下早期宫颈癌的腹腔镜手术对癌细胞种植和转移的影响

Impact of Carbon Dioxide Pneumoperitoneum-laparoscopic Surgery on Tumor Seeding and Metastases in Early-stage Cervical Cancer

目的:探讨早期宫颈癌的CO2气腹腹腔镜手术对肿瘤种植和转移的可能影响。方法:选取佛山市第一人民医院2005年9月至2006年9月行腹腔镜手术的宫颈癌20例和同期行开腹手术10例(FIGO临床分期Ⅰa2～Ⅱa)。腹腔镜手术采用全自动气腹机形成CO2气腹,每充气流量设定4～6L/min,腹腔内CO2气腹压力均维持在13mmHg。收集20例腹腔镜手术开始和结束前的腹腔冲洗液、术中CO2气体滤过液和器械冲洗液行肿瘤细胞学检查。DAKOEnVision二步法检测手术开始前和结束后癌组织的E-cadherin、β-catenin、P-selectin、MMP-2、VEGF和CD44v6蛋白表达。结果:20例腹腔镜手术开始时和结束前的腹腔冲洗液、CO2气体滤过液和器械冲洗液的肿瘤细胞学检查均未见癌细胞。E-cadherin、β-catenin蛋白的异常表达在腹腔镜组和开腹组手术前、后比较无统计学差异(P>0.05);两组间两种指标的异常表达变化亦无统计学差异(P>0.05)。分别比较两种术式手术前、后MMP-2、P-selectin、VEGF和CD44v6蛋白表达均无统计学差异(P>0.05);两组间四种指标的表达变化亦无统计学意义(P>0.05)。腹腔镜组随访15～27个月(24.85±3.53),无复发;开腹组随访15～27个月(24.20±4.47),1例阴道残端复发。结论:20例早期宫颈癌腹腔镜手术未影响E-cadherin、β-catenin、P-selectin、MMP-2、VEGF和CD44v6的表达,未找到其促进宫颈癌组织种植和转移的依据。

Objective： To explore the influence of carbon dioxide pneumoperitoneum-laparoscopic surgery on tumor cell seeding and metastases in early-stage cervical cancer. Methods： From September 2005 to September 2006, 20 patients with cervical cancer who underwent laparoscopic surgery and 10 patients with cervical cancer who underwent laparotomic surgery were selected. Each patient was FIGO stage Ⅰa2-Ⅱa. Carbon dioxide pneumoperitoneum was established and maintained with CO2 insufflation at 4-6L/min and intraperitoneal pressure of 13 mmHg with an automatic pneumoperitoneum machine. Cytologic examination of peritoneal fluid （at the beginning and end of operation）, CO2 filtrated gas and the lavage fluid of instruments during the laparoscopic surgery were performed. The protein expression of E-cadherin, β-catenin, P-selectin, matrix metalloproteinase-2 （MMP-2）, vascular endothelial growth factor （VEGF）, and CD44v6 in tumor tissues before and after operation were detected by DAKO Envision. Results： There were no cases of positive washing cytology in peritoneal fluid, CO2 filtrated gas and the lavage fluid of instruments during the laparoscopic surgery. For laparoscopic group and laparotomin group, no significant difference was found in the abnormal protein expression of E-cadherin and β-catenin between pre- and post-operative samples （p〉0.05）. The difference in abnormal expression of E-cadherin and β-catenin protein between the two groups were not statistically significant （P〉 0.05）. The protein expression of MMP-2, P-selectin, VEGF and CD44v6 were not significantly different between the pre-and post-operative samples in laparoscopic group and laparotomic group （P〉0.05）. The follow-up period was 15-27 （24.85±3.53） months in the laparoscopic group and 15-27 （24.20±4.47） months in the laparotomy group. No recurrence was observed in laparoscopic group. One case of recurrence was seen in laparotomy group. Conclusion： Laparoscopic surgery for cervical cancer has no effect on protein expression of E-cadherin, β-catenin, P-selectin, MMP-2, VEGF, and CD44v6 in tumor tissues. There is no evidence that CO2 pneumoperitoneum-laparoscopic surgery may promote seeding and metastasis of early cervical cancer.