医学
气腹
腹腔镜检查
胸腔镜检查
动物模型
外科
胃肠病学
内科学
作者
Marc‐André Reymond,Claus Schneider,W. Hohenberger,F. Köckerling
出处
期刊:Digestive Surgery
[S. Karger AG]
日期:1998-01-01
卷期号:15 (2): 105-109
被引量:36
摘要
Port site recurrences (PSR) are abdominal wall recurrences that occur within a trocar site after cancer laparoscopy and that are not associated with peritoneal carcinosis. The short clinical delay of occurrence of PSR (median 190 days in colorectal cancer) suggests a massive cell seeding into the abdominal wall (over 10<sup>6</sup> cells) during the operation. In human and animal studies, CO<sub>2</sub> was not able to aerosolize large numbers of tumor cells using pressures of 8–15 mm Hg, even though isolated mesothelial cells have been found in the aerosol. Such large numbers of tumor cells have only been demonstrated on instruments and trocars. PSR occur not only after CO<sub>2</sub> laparoscopy, but also after thoracoscopy, where no CO<sub>2</sub> is used. Gaseless laparoscopy was able to reduce, but not to eliminate port site contamination in animal models. Tumor growth was enhanced in numerous animal models using CO<sub>2</sub>, suggesting an adjuvant effect on tumor growth in the trocar wound. Nevertheless, reported clinical incidences between 0 and 21% suggest that PSR might be a surgeon-related variable dependent mainly on experience and technical expertise. Technical measures have been proposed that might reduce the incidence of PSR.
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