腹腔镜胃癌手术对胃癌细胞腹腔种植转移影响的临床研究

Clinical investigation of implantation metastasis after laparoscopic gastric resection

目的探讨腹腔镜胃癌手术和开腹胃癌手术对胃癌细胞种植转移的影响。方法收集2006年4月至2006年11月间腹腔镜胃癌手术中的45例和开腹胃癌手术中的41例患者术前、术后腹腔冲洗液各100ml,进行腹腔脱落肿瘤细胞学检查。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,收集过滤液进行肿瘤细胞学检查。腹腔镜组术后用100ml生理盐水冲洗腹腔镜手术器械,进行腹腔镜器械冲洗液肿瘤细胞学检查。所有液体离心取沉淀,涂片固定HE染色,光镜下观察肿瘤细胞。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3例阳性(6.7%);两组术前腹腔冲洗液中肿瘤细胞的阳性率分别为60.0%和60.9%,术后肿瘤细胞阳性率分别为53.3%和56.1%,两种手术方式术前、术后腹腔冲洗液肿瘤细胞无明显差异。腹腔冲洗液与胃癌TNM分期有关,两组肿瘤细胞Ⅲ期阳性率均显著高于Ⅱ期,具有非常显著统计学差异(P<0.01),即两组中胃癌细胞阳性检出率在肿瘤的病理分期越晚,阳性率越高。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。

Objective To compare the risk of cancer cell implantation metastasis after laparoscopic gastric resection and conventional open gastric resection. Methods From April 2006 to November 2006 intraoperative peritoneal exfbliocytology examination was performed in 45 patients during laparoscopie gastric resection and in 41 patients who underwent conventional surgery. I00 ml saline was poured into the perito- neal cavity and was retrieved by suction after irregation. Cytological examination was clone immediately after opening the peritoneal cavity and just before closing the abdomen. Laparoscopic instruments were lavaged af- ter surgery by 100 ml saline, CO2 was evacuated through the side orifice of trocar after pneumoperitoneum during laparoscopic gastrectomy, filtered through 100 ml saline, and then tumor cytological examination of CO2 gas filtration was carried out. Laparoscopic instrument was flushed by 100 ml saline after surgery, and cytological examination of the filtration was performed. Smear, fixation after HE staining, and tumor cells were observed by a photomieroscope. Results Malignant cells were not detected in CO2 gas filtration. The incidence of positive cytology in the lavaged fluid of instruments during laparoseopie surgery was 6.7 percent. The incidence of positive cytology in the pre-lavaged fluid during laparoscopic surgery was 60.0%, and in the post-lavaged fluid after surgery was 53.3%. The incidence of positive cytology in the pre-lavaged fluid during conventional surgery was 60.9% , and in the post-lavage after surgery was 56.1%. There was no significant difference between two the groups. The positive rate of lavaged fluid was correlated with the TNM stages of gastric tumor. The positive incidence of m stage was higher than that of II stage （P 〈0. 01 ）. Conclusion C02 pneumoperitoneum does not affect tumor cell implantation metastasis during laparoscopic gastric resection. Frequent contact between wounds and contaminated laparoscopic instrument explains cancer recurrence at trocar insertion. Compared with conventional techniques, laparoscopic surgery in gastric cancer does not increase the risk of intraperitoneal cancer cell dissemination.