CO2气腹下子宫内膜癌腹腔镜手术对癌细胞种植和转移的影响  

Effect of carbon dioxide pneumoperitoneum-laparoscopic surgery on tumor seeding and metastases in endometrial cancer

作　　者：符淳[1] 李光仪[2] 刘凤英[1] 林秋华[1] 方小玲[1] 

机构地区：[1]中南大学湘雅二医院妇产科,长沙410011 [2]佛山市第一人民医院妇产科,广东佛山528000

出　　处：《中南大学学报（医学版）》2008年第2期130-137,共8页Journal of Central South University ：Medical Science

基　　金：广东省卫生厅基金资助项目(B2006133)~~

摘　　要：目的：探讨子宫内膜癌的CO2气腹腹腔镜手术对肿瘤种植和转移的可能影响。方法：选择病灶局限于子宫且子宫大小不超过12孕周，行腹腔镜手术的内膜癌病例20例和同期行开腹手术的病例10例。腹腔镜手术采用全自动气腹机形成CO2气腹，充气流量设定为4～6L／min，腹腔内CO2气腹压力均维持在13mmHg。收集20例腹腔镜手术开始和结束前的腹腔冲洗液、术中CO2气体滤过液和器械冲洗液行肿瘤细胞学检查。DAKO Envision二步法检测手术开始前和结束时癌组织的E-cadherin，β-catenin，P-selectin，MMP-2，VEGF和CD44v6蛋白表达。结果：20例腹腔镜手术刚开始和结束前的腹腔冲洗液、CO2气体滤过液和器械冲洗液的肿瘤细胞学检查均未找到癌细胞。E-cadherin和β-catenin在内膜癌中呈明显异常表达，腹腔镜组和开腹组手术前后这两种蛋白的异常表达比较无统计学差异（P〉0．05）；两组间这两种指标的异常表达变化亦无统计学差异（P〉0．05）。两种术式手术前后MMP-2，P-selectin，VEGF和CD44v6蛋白表迭比较无统计学差异（P〉0．05）；两组间这4种指标的表达变化亦无统计学差异（P〉0．05）。腹腔镜组随访（7～19）（14．25±3．65）月，并发泌尿系感染1例；开腹组随访（7～19）（13．10±4．23）月，并发下肢静脉血栓1例；均经对症治疗后好转出院。结论：20例子宫内膜癌的腹腔镜手术没有影响E-cadherin，β-catenin，P-selectin，MMP-2，VEGF和CD44v6的表达，未找到该术式改变内膜癌组织种植和转移的依据。Objective To explore the influence of carbon dioxide pneumoperitoneum-laparoscopic surgery on tumor cell seeding and metastases in endometrial cancer. Methods Twenty patients with endometrial cancer who underwent laparoscopic surgery and 10 patients with endometrial cancer who underwent laparotomic surgery were enrolled. Each patient was in preoperative clinical Stage I and the uterus size in each patient was less than 12 weeks of pregnancy. Carbon dioxide pneumoperitoneum was established and maintained with CO2 insufflation at 4 -6 L/min and intraperitoneal pressure of 13 mmHg with an automatic pneumoperitoneum machine. Cytologic examination of peritoneal fluid （at the beginning and end of the operation ） , CO2 filtrated gas and the lavage fluid of instruments during the laparoscopic surgery were performed. The protein expressions of E-cadherin, β-cate- nin, P-selectin, matrix metalloproteinase-2 （ MMP-2 ） , vascular endothelial growth factor （ VEGF ） , and CD44v6 in tumor tissues before and after the operation were detected by DAKO Envision. Resuits There were no case of positive washing cytology in the peritoneal fluid, CO2 filtrated gas, and the lavage fluid of instruments during the laparoscopic surgery. The expressions of E-cadherin and β- catenin proteins were obviously abnormal in endometrial cancer. The abnormal expressions of E-cad- herin and β-catenin protein between the pre- and post-operations were not significantly different in both the laparoscopic group and the laparotomic group （ P 〉 0.05 ）. The changes of abnormal expressions of E-cadherin and β-catenin protein were no statistical difference between the two groups （ P 〉 0.05 ）. The positive protein expressions of P-selectin, MMP-2, VEGF, and CD44v6 were not significantly different between the pre- and post-operations both in the laparoscopic group and the laparotomic group （ P 〉 0. 05 ） , and there was also no significant difference between the laparoscopic group and the laparotomic group （ P 〉 0.05 ）. The

关 键 词：内膜肿瘤 子宫 气腹 人工 腹腔镜外科手术 种植 转移 

分 类 号：R737.33[医药卫生—肿瘤]