CO_2人工气腹对裸鼠腹腔子宫内膜癌细胞模型切口转移、生长和腹腔播散影响

Effects of CO_2 pneumoperitoneum on abdominal wall metastasis and the intraperitoneal tumor growth and the tumor dissemination:a nude rat human endometrial carcinoma model

目的 探讨CO2 人工气腹术对裸鼠子宫内膜癌细胞模型切口转移、生长、腹腔种植、播散影响。方法 4 5只裸鼠随机分成 :(1 )对照组 :仅给予麻醉 ,右下腹腔注射子宫内膜癌细胞 ;(2 )开腹组 :脐耻正中切口 4cm ,肠管外置 5min后右下腹腔注射子宫内膜癌细胞 ;(3)气腹组 :剑突至耻骨垂直正中处穿刺后腹腔内建立 4mmHg(1mmHg =0 1 33kPa)CO2 人工气腹 ,5min后右下腹腔注射子宫内膜癌细胞。注射子宫内膜癌细胞珠 (HEC 1 B)数量 :2 .2× 1 0 6个 /只 ,实验时间 :4 5min。 4周后 ,观察裸鼠体重改变、腹壁切口肿瘤转移情况。测量腹壁转移肿瘤最大直径和重量 ,运用半定量评分系统对腹腔各脏器肿瘤种植、播散情况进行评分、行组间比较。结果 开腹组裸鼠体重下降显著高于人工气腹组 ,分别为 (2 .4 2± 2 .31 )g和 (0 .30± 1 .72 )g ,(P <0 .0 5 )。人工气腹组切口肿瘤转移率显著大于开腹组 ,分别为 (86 .6 7%和 38.4 6 % ) ,(P <0 .0 5 ) ,平均腹壁转移肿瘤最大直径、重量 ,人工气腹组显著大于开腹组 ,分别为 (4 .93± 3.2 2 )mm和 (1 .77± 2 .39)mm、(4 2 .2 9± 2 8.80 )mg和 (1 9.2 2± 2 7.1 7)mg ,(P <0 .0 1和P <0 .0 5 )。人工气腹组脏器平均播散得分值显著高于开腹组 ,分别为 (9.80± 5 .6 2和 3.

Objective To compare tumor growth,intraperitoneal implantation,and port site metastases occurrence after laparotomy and CO 2 pneumoperitoneum in an athymic rat endometrial carcinoma model.Methods A suspension of 2.2×10 6 viable human endometrial carcinoma cell line(HEC 1 B) was introduced into the right lower quadrant of the abdomen of 45 nude rats at control group (only anesthetized without any interference),laparotomy group with 4 cm vertical midline,and laparoscopy group with CO 2 insufflation at 4mmHg pressure(15 rats in each group).Four weeks later,the changes of weight of all rats in two groups were compared and the peritoneal cavity and surgical wounds were examined for macroscopic evidence of implanted tumour.Max diameters and weights of port site were determined.Intraperitoneal tumor growth and the tumor dissemination were evaluated semiquantitatively with a scoring system.The scores attributed to each organ were added to calculate the dissemination score of each animal and scores of each group were obtained according to the above scores.Results Compared with that in the laparoscopy group,the weight of nude rats in the laparotomy was significantly dropped,(2.42±2.31)g vs (0.30±1.72)g,respectively( P < 0.05 ).The incidence of wound metastasis was 86.67% in the CO 2 pneumoperitoneum group and 38.46% in the laparotomy group,respectively,( P < 0.05 ).The mean max diameters and mean weights of port site tumor of nude rats were significantly increased undergoing laparoscopy with CO 2 pneumoperitoneum than laparotomy,(4.93±3.22)mm vs(1.77±2.39)mm,and ( 42.29 ±28.80)mg vs (19.22±27.17)mg,respectively,( P <0.01, P <0.05).The mean dissemination score was (9.80±5.62)in the CO 2 pneumoperitoneum group and (3.31±3.12)in the laparotomy group,respectively ( P <0.01).The incidence of metastasis of liver was significantly higher in the CO 2 pneumoperitoneum group than in the laparotomy group(66.67% vs 15.38%),respectively ( P <0.01).The spreading scores of livers and intestines in the CO 2 pneumoperitoneum group were higher than those in the laparotomy group(4.07±4.23 vs 0.15 ± 0.55 ;5.40±2.92 vs 2.85±2.61),respectively( P <0.01)).The incidence of the liver abscess and necrosis were significantly higher in the laparotomy group than that in the CO 2 pneumoperitoneum group(69.23% vs 20.00%),),respectively ( P <0.05).Conclusion In this model,CO 2 insufflation during laparoscopy resulted in widespread tumour dissemination and implantation,when compared to laparotomy,supporting the postulate that CO 2 insufflation may have some potentially nutritional effects.