CO_2气腹对妇科恶性肿瘤患者腹膜IL-6表达的影响  

Effect of carbon dioxide pneumoperitoneum on expression of IL-6 in peritoneum of patients with gynecological malignancy

作　　者：沈育红[1] 王岳萍[1] 龙雯晴[1] 喇端端[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院妇产科,上海200025

出　　处：《中国医药科学》2013年第10期14-16,57,共4页China Medicine And Pharmacy

摘　　要：目的研究妇科恶性肿瘤患者进行腹腔镜手术时CO2气腹对腹膜间皮细胞中IL-6表达的影响,探讨CO2气腹环境下腹膜抗肿瘤免疫改变的机制。方法选择2010年9月～2012年9月就诊于我院的60例妇科肿瘤患者,其中腹腔镜手术恶性肿瘤(包括宫颈癌、子宫内膜癌、卵巢癌)组25例,子宫肌瘤组10例;开腹手术恶性肿瘤(包括宫颈癌、子宫内膜癌、卵巢癌)组15例,子宫肌瘤组10例。在手术开始时、30 min和60 min时采集切口处及远离切口处(麦氏点)壁层腹膜,以免疫组化法测定腹膜间皮细胞IL-6的表达。结果恶性肿瘤腹腔镜组切口处IL-6表达:30 min时为(4.05±1.08)显著低于0 min时的(8.00±2.51)(P<0.05),60 min时为(2.37±1.26)也显著低于30 min时(P<0.05);恶性肿瘤开腹组IL-6表达:60 min时为(4.93±1.58)与0 min时(8.06±2.87)相比有明显下降(P<0.05),但其下降程度显著小于腹腔镜组;IL-6的表达差异在三种恶性肿瘤组间的比较无统计学意义(P>0.05)。子宫肌瘤组切口处IL-6的表达在0 min时开腹组为(5.20±0.79)、腹腔镜组为(5.30±1.70)分别低于恶性肿瘤开腹组(8.00±2.51)、腹腔镜组(8.06±2.87)(P<0.05);子宫肌瘤腹腔镜组手术期间IL-6的表达呈下降趋势,60 min时为(3.20±0.63)相比0 min的(5.30±1.70)差异有统计学意义(P<0.05);子宫肌瘤开腹组IL-6在手术期间的比较差异无统计学意义(P>0.05)。各组切口处在手术60 min时IL-6表达低于远离切口,但比较差异无统计学意义(P>0.05)。结论腹腔镜手术CO2气腹对腹膜IL-6表达有抑制,在妇科恶性肿瘤中的抑制比良性肿瘤更为显著,说明CO2气腹损伤腹膜免疫,可能对恶性肿瘤转移有促进作用,但CO2气腹对切口处的免疫抑制可能不是术后切口肿瘤种植转移的直接原因。Objective To evaluate the effect of carbon dioxide pneumoperitoneum on expression of IL-6 in peritoneum of patients with gynecological malignancy. Methods Sixty women with gynecological tumor were divided into four groups：10 patients in myoma laparoseopy group. 10 patients were in myoma laparotomy group. 25 patients in cancer laparoscopy group （including cervical cancer, ovary cancer, endometrial cancer）; 15 patients were in cancer laparotomy group. The expression of IL-6 of peritoneal mesothelial cells were measured at various time points （the beginning of operation, 30 minutes and 60 minutes intraoperatively） and various positions （near or far away from the port site/incision） through immunohistoehemistry. Results In malignant group, the expression of IL-6 in laparoscopic surgery were significantly decreasing （P 〈 0.05）. The expression at 60 rain was lower than 30 rain （P 〈 0.05）. In laparotomy group, the expression of IL-6 only slowly decreased at 60 rain and its expression degree were higher than that in laparoscopic group. There was no comparative difference in different type of malignant tumor（P 〉 0.05）. At 0 min point, the expression of IL-6 was lower in benign group than in malignant group and it was decreasing as the laparoscopic surgery time going, 60 rain was lower than 0 min（P 〈 0.05）. The expression of IL-6 has no significant difference in benign group as the open surgery time going. At 60 rain in all group, IL-6 was lower at incision than at far away from incision position, but there was no significant difference（P 〉 0.05）. Conclusion Carbon dioxide pneumoperitoneum used in laparoscopic surgery significantly decrease the expression of IL-6 of peritoneal mesothelial cells anti the expression decreased as the surgery time going. It suggested that carbon dioxide pneumoporitoneum may depress the defense and immunity of the peritoneum, which could increase the risk of tumor spread in laparoscopic gynecologic cancer surgery. The lower expression of IL-6

关 键 词：CO2 腹腔镜 恶性肿瘤 腹膜 白细胞介素-6 

分 类 号：R737.3[医药卫生—肿瘤]