腹腔镜结、直肠癌手术切口及脏器转移的实验研究

Impact of laparoscopic colorectal surgery on port-site and viscera metastasis.

目的 研究腹腔镜结直肠癌手术对肿瘤切口种植及脏器转移的影响。方法 选用人结肠癌细胞 (Lo Vo细胞 )悬液 (1× 10 7/L) ,OT针注入雌性Balb/C裸鼠盲肠浆膜下 (0 1mL) ,建立人结肠癌细胞裸鼠原位种植模型。 2周后 ,实验裸鼠随机分为 3组 :CO2 人工气腹术组 (31只 )、剖腹术组 (31只 )、和未行手术组 (30只 )。 10周后 ,3组裸鼠均脱颈法处死 ,探查肿瘤细胞原位种植及致瘤鼠肿瘤细胞切口种植及各脏器转移情况。结果 (1) 3组裸鼠的致瘤率为 :CO2 人工气腹组 2 3/ 31例 ,开腹术组 2 2 / 31例 ,未手术组 2 1/ 30例 ,差异无显著意义。 (2 )CO2 人工气腹术组的 2 3只致瘤鼠中 ,有 2只发生切口种植 ,12只发生脏器转移 ;开腹术组的 2 2只致瘤鼠中 ,有 4只发生切口种植 ,13只发生脏器转移 ;未手术组 2 1只致瘤鼠中 ,有 10只发生脏器转移 ,致瘤裸鼠的切口种植及脏器转移率差异无显著意义。结论 CO2 人工气腹没有促进人结肠癌细胞裸鼠原位种植模型切口种植及脏器转移的发生 ,腹腔镜结直肠癌手术具有一定的安全性与可行性。

Objective To evaluate the impact of laparoscopic colorectal surgery on the port-site and viscera metastasis of colon cancer cells in nude mice .Methods Patient-like metastatic model was established in female Balb/C mice (n=92) via orthotopic injection of human colon cancer cells suspension (LoVo cells 0 1ml,1×10 7/L) into caecum wall.Two weeks later, the nude mice were randomly divided into three groups:a CO 2 pneumoperitoneum group(n=31),a laparotomy group (n=31),an unoperated group(n=30) .Ten weeks later sacrificed the nude mice, investigated the implantation and metastasis of tumor cells,and the rate of port-site and viscera metastasis in nude mice with colon tumors was recorded and compared by χ 2 test among the three groups.Results (1)Colon tumor formation occurred in 23/31 mice of the CO 2 pneumoperitoneum group , in 22/31 mice of the laparotomy group, in 21/30 mice of the unoperated group,no significant difference existed.(2)In nude mice with colon tumors ,there was no significant difference between the rate of port-site metastasis in the CO 2 pneumoperitoneum group(2/23) and that in the laparotomy group(4/22),and there was no significant difference when the rates of viscera metastasis were compared among CO 2 pneumoperitoneum group(12/23),laparotomy group(13/22) and unoperated group(10/21). Conclusion The CO 2 pneumoperitoneum does not significantly stimulate the metastasis of colon cancer cells to port-site and viscera in nude mice,laparoscopic surgery in colorectal cancer is safe and feasible.