腹腔镜结直肠癌手术对肿瘤细胞种植转移的影响

Effect of colorectal laparoscopic surgery on tumor cell seeding

目的比较腹腔镜结直肠癌手术和开腹结直肠癌手术对肿瘤细胞种植的影响。方法分析2013年6月至2015年6月大连大学附属中山医院普通外科收治的腹腔镜结直肠癌手术(腹腔镜组)和开腹结直肠癌手术(开腹组)患者各40例,对腹腔脱落肿瘤细胞进行收集、检查,对腹腔冲洗液、CO2气体滤过液以及腔镜器械冲洗液进行肿瘤细胞学检查。结果腹腔镜组病例的气体滤过液中没有发现肿瘤细胞,仅发现少量细胞碎片,在腹腔镜器械冲洗液中发现1例肿瘤细胞阳性。腹腔镜结直肠癌手术术前的冲洗液肿瘤细胞阳性率为35%,手术后为10%,而开腹结直肠癌手术在手术之前的冲洗液肿瘤细胞阳性率为35%,手术后为15%。结论 CO2气腹状态中细胞的雾化不是能构成切口肿瘤细胞种植转移的重要因素。腹腔镜术中器械污染是引起切口肿瘤细胞种植转移的主要原因之一,腹腔镜手术不会增加肿瘤细胞种植的机会。

Objective To compare the effect of colorectal laparoscopic surgery and conventionalsurgery on tumor cell seeding. Methods From June 2013 to June 2015, intraoperative peritoneal lavage cytology was performed in 40 patients with colorectal cancer during colorectal laparoscopic surgery and in 40 patientswith conventional surgery in the authors’ affiliated hospital. Malignant cells of the abdominal cavity were col.lected and examined, and the tumor cytological examination was performed on peritoneal washing liquid, CO2gas filtrates and the lavage fluid of cavity mirror apparatus. Results Malignant cells were not detected in CO2gas filtered fluid in the colorectal laparoscopic group. Only a small number of cell fragments were found. A caseof positive tumor cell was found in the laparoscopic instrument lavage fluid. The incidence of positive cytology inthe prelavage during laparoscopic surgery was 35%,and that in the postlavage was 10%. The incidence of posi.tive cytology in the prelavage during conventional surgery was 35%, and that in the postlavage was 15%. Con.clusions CO2 pneumoperitoneum does not affect tumor cell seeding during colorectal laparoscopic surgery. Fre.quent contact between wounds and contaminated laparoscopic instruments were proposed to explain the phenome.non of cancer recurrence at trocar insertion. Laparoscopic techniques in colorectal cancer surgery does not in.crease risk of intraperitoneal cancer cell dissemination compared with conventional techniques.