标题：腹腔镜结直肠癌手术对肿瘤细胞种植转移的影响

      作者：沈新 1，马佳佳 2，徐阳 1，张毅 3，施海 3    1.济南军区总医院普通外科，山东 济南 250031；2.空军军医大学西京医院妇产科，陕西 西安 710032；3.西安市第三医院普外科，陕西 西安 710061

      卷次： 2019年30卷17期

      【摘要】 目的 探讨腹腔镜结直肠癌手术对肿瘤细胞种植转移的影响。方法 选择2014年6月至2016年1月间济南军区总医院普外科52例行腹腔镜结直肠癌手术(腹腔镜组)和48例开腹结直肠癌手术患者(开腹组)为研究对象，两组患者术中均收集腹腔脱落肿瘤细胞，检测腹腔冲洗液、CO2气体滤过液、器械冲洗液中肿瘤细胞阳性率。所有患者随访至2019年1月，观察两组患者种植性转移/复发、生存率的差异。结果 腹腔镜组患者的CO2气体滤过液中检出肿瘤细胞1例，腔镜器械冲洗液中2例，腹腔镜组和开腹组术前(34.62% vs 33.33%)、术后(19.23% vs25.00%)腹腔冲洗液中肿瘤细胞阳性率比较，差异均无统计学意义(P>0.05)；腹腔镜组与开腹组患者种植性转移(11.54% vs 8.33%)、复发(15.38% vs 20.83%)、死亡率(4.00% vs 6.67%)、3年生存率(83.12% vs 85.36%)比较，差异均无统计学意义(P>0.05)。结论 腹腔镜结直肠癌手术CO2气腹可能对切口肿瘤细胞种植转移造成影响，但并未增加肿瘤细胞种植性转移、复发和死亡风险。
      【关键词】 腹腔镜；结直肠癌；肿瘤细胞；种植转移；结肠；直肠
      【中图分类号】 R735 【文献标识码】 A 【文章编号】 1003—6350（2019）17—2220—03

Effect of laparoscopic colorectal cancer surgery on implantation and metastasis of cancer cells.
SHEN Xin 1, MAJia-jia 2, XU Yang 1, ZHANG Yi 3, SHI Hai 3. 1.Department of General Surgery, General Hospital of Jinan Military Region,Jinan 250031, Shandong, CHINA; 2. Department of Obstetrics and Gynecology, Xijing Hospital, Air Force Military MedicalUniversity, Xi'an 710032, Shaanxi, CHINA; 3. Department of General Surgery, the Third Hospital of Xi'an, Xi'an 710061,Shaanxi, CHINA
【Abstract】 Objective To investigate the effect of laparoscopic colorectal cancer surgery on implantation andmetastasis of cancer cells. Methods From June 2014 to January 2016, 52 patients with colorectal cancer undergoinglaparoscopic colorectal cancer surgery (laparoscopic group) and 48 patients undergoing open colorectal cancer surgery(open group) in General Hospital of Jinan Military Region were selected as the study subjects. Tumor cells were collect-ed from abdominal cavity during operation in both groups, and the positive rates of tumor cells in peritoneal lavage fluid,CO2 gas filtrate fluid and instrument lavage fluid were detected. All patients were followed up until January 2019 to ob-serve the difference of implant metastasis/recurrence and survival rate between the two groups. Results One case oftumor cells was detected in the CO2 gas filtrate of the laparoscopic group, two cases in the lavage fluid of laparoscopicinstruments, and there was no significant difference in the positive rate of tumor cells in the peritoneal lavage fluid be-tween the laparoscopic group and open group before operation (34.62% vs 33.33% ) and after operation (19.23% vs25.00% , P>0.05. There were no significant differences in implantable metastasis (11.54% vs 8.33% ), recurrence(15.38% vs 20.83%), mortality (4.00% vs 6.67%) and 3-year survival (83.12% vs 85.36%) between the laparoscopicgroup and open group (P>0.05). Conclusion CO2 pneumoperitoneum for laparoscopic surgery may affect the im-plantation and metastasis of tumor cells in incision, but does not increase the risk of implantation, recurrence or deathof tumor cells.
      【Key words】 Laparoscopy; Colorectal cancer; Cancer cells; Implantation metastasis; Colon; Rectum