腹腔镜胃癌根治术对癌细胞腹腔种植转移的影响

Clinical study on the plantation of peritoneal metastasis of gastric cancer after laparoscopic operation

目的探讨腹腔镜胃癌根治术对癌细胞腹腔种植转移的影响。方法选取2011年9月至2014年1月收治的胃癌手术131例患者,分为开腹组行开腹手术65例,腹腔镜组行腹腔镜手术66例。分别取两组手术前后腹腔冲洗液、腹腔镜组CO2气体滤过液、两组术后手术器械冲洗液进行脱落肿瘤细胞学检查。结果腹腔镜组和开腹组术前术后腹腔冲洗液阳性肿瘤细胞结果对比,差异均无统计学意义(P>0.05);腹腔镜组CO2气体滤过液中未发现任何肿瘤阳性细胞;腹腔镜组和开腹组器械冲洗液肿瘤细胞阳性率对比,差异无统计学意义(P>0.05);腹腔镜手术Ⅱ期、Ⅲ期术前术后腹腔冲洗液肿瘤细胞阳性率与开腹手术比较,差异无统计学意义(P>0.05)。两组III期腹腔冲洗液肿瘤细胞阳性率均显著高于Ⅱ期阳性率,且差异有统计学意义(P<0.05);即两组TNM分期越晚,阳性率越高。结论腹腔镜胃癌手术与开腹手术对肿瘤细胞腹腔种植转移的影响相当,CO2气腹未增加肿瘤细胞的传播途径,腹腔镜手术器械污染是引起胃癌细胞转移的主要原因之一。

Objectine To explore the planting metastasis of cancer cells after peritonescopic radical resection of gastric cancer,and to provide reference for its clinical diagnosis and treatment. Methods A total of 131 patients with gastric cancer operated during September 2011 to January 2014,they were divided into laparotomic group and laparoscopic group. Sixty five cases underwent laparotomy were allocated in laparotom-ic group,and 66 cases underwent laparoscopic operation were allocated in laparoscopic operation group. The peritoneal lavage fluid,CO2 gas filtra-tion liquid and equipment cleaning fluid after the operation of patients in these 2 groups were underwent exfoliated tumor cytological examination. Results The difference in positive tumor cells in peritoneal lavage fluid and contrast fluid between laparoscopic group and laparotomy group before and after surgery was not statistically significant（ P ﹥ 0. 05）. No positive tumor cell could be found in CO2 gas filtration liquid in laparoscopic group. In comparison with the positive rate of tumor cells in equipment washing fluid between laparoscopic group and laparotomic group,the differ-ence was not significant（ P ﹥ 0. 05）. The positive rates of tumor cells between patients with laparoscopic operation stage II and III and laparotom-ic group before and after operation had no significant difference（ P ﹥ 0. 05）. The positive rates of tumor cells in group III of both groups were sig-nificantly higher than those of group II,and the difference was statistically significant（ P ﹤ 0. 05）. Patients in earlier TNM stage,the higher would be the positive rate. Conclusion In comparison with laparoscopic operation and open abdominal operation on peritoneal metastasis of tumor cells,CO2 pneumoperitoneum,does not increase the transmission route of tumor cells. The contamination of tumor cells in laparoscopic operation is one of main causes for metastasis of gastric cancer cells.