持续性CO_2气腹影响胃癌细胞腹腔镜切口种植的实验研究

An experimental research on continuous CO_2 pneumoperitoneum in relation with tumor cell port site implantation in laparoscopic surgery in a murine model

目的 为了进一步阐明腹腔镜肿瘤外科手术切口种植的原因,本文观察实验鼠CO2气腹对肿瘤细胞切口播散的影响。方法 雄性SD大鼠腹腔内注入不同量人胃癌细胞株SGC-7901,气腹机分别产生腹腔不同压力的持续性气腹,通过5mm腹腔穿刺管收集气体至培养瓶中,37℃、5％CO2环境中培养7天后,显微镜下鉴定是否有肿瘤细胞生长,另取腹腔冲洗液作阳性对照。结果 注入106/ml浓度的胃癌细胞,气腹压达30 mm Hg,流量为5L//min,持续60min、120min及180min后,部分培养瓶中发现有肿瘤细胞生长(P<0.001)。而在注入104/ml胃癌细胞所收集的气体中未发现肿瘤细胞。结论 106/ml肿瘤细胞数量下,高气腹压(30 mm Hg)、长时间(60min)是可以造成肿瘤细胞切口播散的。实验结果为临床上如何有效地预防腹腔镜肿瘤手术切口种植方面提供了参考依据,有一定的实用价值。

Objective In order to better understand the possibility of high port - site recurrence in laparoscopic surgery. The aim of this study was to inject the gastric cancer cells into the peritoneal cavity and determine the tumor cell movement during continuous CO2 pneumoperitoneum in a murine model. Methods Male Spraque - Dawley rats were given intraperitoneal injections of gastric cancer cells(cell line SGC - 7901) . Continuous CO2 pneumo of 15mmHg or 30mmHg for 5mins,60mins, 120mins and 180mins with different number of tumor cell injection(10 /ml, 10 /ml respectively) were investigated. Several samples of peritoneal washing served as positive control. All collectiong dishes were incubated at 37℃ with 5 % CO2 concentration for one week. Results After one week of incubation, some of the dishes which were continuous flows of C02 gas (5L/min) at pneumo 30mmHg for 60mins or longer demonstrated tumor growth, and all peritoneal washing samples showed tumor growth. However, other dishes showed negative. Conclusion It suggests that gastric cancer cells can cause port - site implantation, and the number of tumor cells, pneumoperitoneum pressure and the duration may also affect the occurrence of port site implantation ( P < 0.001) . It could be helpful for finding a suitable way to prevent the port site implantation in the clinics.