• 第三軍醫(yī)大學(xué)西南醫(yī)院全軍普通外科中心，微創(chuàng)胃腸外科中心(重慶400038);

目的探討模擬不同壓力CO2氣腹環(huán)境下小鼠胃癌腹腔巨噬細胞功能變化以及對胃癌腹腔種植轉(zhuǎn)移的影響。方法建立小鼠前胃癌615小鼠原位種植模型，將其隨機分為5組，每組30只: 單純麻醉組、開腹組以及2、4和6 mm Hg (1 mm Hg=0.133 kPa) CO2氣腹組。術(shù)后每組各取6只小鼠收集培養(yǎng)腹膜巨噬細胞，培養(yǎng)12、24、48和72 h，檢測巨噬細胞吞噬功能及NO和TNFα水平。其余小鼠術(shù)后2周時觀察小鼠前胃癌細胞腹腔種植轉(zhuǎn)移率及種植結(jié)節(jié)的總重量。結(jié)果各組小鼠術(shù)后均無死亡，無腹水產(chǎn)生，各組小鼠平均體重的差異無統(tǒng)計學(xué)意義(P gt;0.05)。在培養(yǎng)12 h時，開腹組小鼠術(shù)后腹腔巨噬細胞吞噬中性紅值、NO和TNF-α水平均明顯高于其他4組(P lt;0.05)，而單純麻醉組小鼠又明顯高于2、4和6 mm Hg CO2氣腹組(P lt;0.05); 2 mm Hg CO2氣腹組明顯高于4和6 mm Hg CO2氣腹組(P lt;0.05)，而4 mm Hg和6 mm Hg CO2氣腹組間比較差異無統(tǒng)計學(xué)意義(P gt;0.05)。在培養(yǎng)24 h時，6 mm Hg CO2氣腹組小鼠術(shù)后腹腔巨噬細胞吞噬中性紅值、NO和TNF-α水平均明顯低于其他4組(P lt;0.05)，其他4組間比較差異無統(tǒng)計學(xué)意義(P gt;0.05)。在培養(yǎng)48 h和72 h時，各組小鼠術(shù)后腹腔巨噬細胞吞噬中性紅值、NO和TNF-α水平比較差異均無統(tǒng)計學(xué)意義(P gt;0.05)。單純麻醉組、開腹組以及2、4 和6 mm Hg CO2氣腹組小鼠前胃癌腹腔種植轉(zhuǎn)移率為分別為100%(24/24)、50.0%(10/20)、47.8%(11/23)、45.5%(10/22)和75.0%(15/20)，組間比較6 mm Hg CO2氣腹組明顯低于單純麻醉組(P lt;0.05)而高于其他3組(P lt;0.05)，其他3組間兩兩比較差異均無統(tǒng)計學(xué)意義(P gt;0.05)。單純麻醉組、開腹組以及2、4和6 mm Hg CO2氣腹組小鼠前胃癌腹腔種植結(jié)節(jié)重量分別為(1.24±0.48) g、(1.02±0.38) g、(0.96±0.33) g、(0.93±0.45) g和(1.18±0.37) g，各組間比較差異均無統(tǒng)計學(xué)意義(P gt;0.05)。結(jié)論高壓力(6 mm Hg) CO2氣腹可較長時間抑制胃癌小鼠腹腔巨噬細胞的吞噬與分泌功能，促進胃癌的腹腔種植轉(zhuǎn)移。

引用本文： 羅華星,余佩武,郝迎學(xué),趙永亮,石彥,唐波. 模擬CO2氣腹對小鼠胃癌腹腔巨噬細胞功能的影響. 中國普外基礎(chǔ)與臨床雜志, 2011, 18(2): 116-121. doi: 復(fù)制

1. Kitano S, Iso Y, Moriyama M, et al. Laparoscopyassisted Billroth Ⅰ gastrectomy [J]. Surg Laparosc Endosc, 1994, 4(2): 146148.
2. Kitano S, Shiraishi N, Uyama I, et al. A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan [J]. Ann Surg, 2007, 245(1): 6872.
3. Park JM, Jin SH, Lee SR, et al. Complications with laparoscopically assisted gastrectomy: multivariate analysis of 300 consecutive cases [J]. Surg Endosc, 2008, 22(10): 21332139.
4. 余佩武, 王自強, 錢鋒, 等. 腹腔鏡輔助胃癌根治術(shù)105例 [J]. 中華外科雜志, 2006, 44(19): 13031306.
5. 余佩武, 錢鋒, 羅華星, 等. 腹腔鏡胃癌根治術(shù)的臨床療效 [J]. 中華消化外科雜志, 2008, 7(1): 3840.
6. Hao YX, Zhong H, Zhang C, et al. Effects of simulated carbon dioxide and helium peumoperitoneum on proliferation and apoptosis of gastric cancer cells [J]. World J Gastroenterol, 2008, 14(14): 22412245.
7. 郝迎學(xué), 鐘華, 曾冬竹, 等. 不同壓力二氧化碳氣腹對胃癌細胞增殖運動的影響 [J]. 中華消化外科雜志, 2008, 7(1): 5658.
8. 郝迎學(xué), 鐘華, 張超, 等. 不同壓力二氧化碳氣腹對胃癌細胞遷移運動和細胞骨架的影響 [J]. 中華胃腸外科雜志, 2008, 11(5): 454457.
9. Whelan RL, Franklin M, Holubar SD, et al. Postoperative cellmediated immune response is better preserved after laparoscopic vs open colorectal resection in humans [J]. Surg Endosc, 2003, 17(6): 972978.
10. Gitzelmann CA, MendozaSagaon M, Talamini MA, et al. Cellmediated immune response is better preserved by laparoscopy than laparotomy [J]. Surgery, 2000, 127(1): 6571.
11. Aoyagi K, Kouhuji K, Yano S, et al. VEGF significance in peritoneal recurrence from gastric cancer [J]. Gastric Cancer, 2005, 8(3): 155163.
12. Kumagai K, Shimizu K, Yokoyama N, et al. Gastrointestinal cancer metastasis and lymphatic advancement [J]. Surg Today, 2010, 40(4): 301306.
13. 余佩武, 郝迎學(xué). CO2氣腹對胃腸道腫瘤侵襲轉(zhuǎn)移影響的研究現(xiàn)狀與進展 [J]. 中國普外基礎(chǔ)與臨床雜志, 2009, 16(10): 777780.
14. 劉驊, 周敏, 趙文毅, 等. 不同壓強與時程CO2氣腹對胃癌細胞黏附侵襲能力的影響 [J]. 中國普外基礎(chǔ)與臨床雜志, 2010, 17(6): 557561.
15. Nakada H, Ishida H, Hashimoto D, et al. Influence of different pneumoperitoneal pressures on tumor cell distribution rats [J]. Surg Endosc, 2005, 19(4): 563568.
16. Tang CL, Eu KW, TaiBC, et al. Randomized clinical trail of the effect of open versus laparoscopically assisted colectomy on systemic immunity in patients with colorectal cancer [J]. Br J Surg, 2001, 88(6): 801807.
17. Wichmann MW, Hüttl TP, Winter H, et al. Immunological effects of laparoscopic vs open colorectal surgery: a prospective clinical study [J]. Arch Surg, 2005, 140(7): 692697.
18. Are C, Talamini MA. Laparoscopy and malignancy [J]. J Laparoendosc Adv Surg Tech A, 2005, 15(1): 3847.
19. Nakamura T, Mitomi H, Ohtani Y, et al. Comparison of longterm outcome of laparoscopic and conventional surgery for advanced colon and rectosigmoid cancer [J]. Hepatogastroenterology, 2006, 53(69): 351353.
20. Ost MC, Tan BJ, Lee BR. Urological　laparoscopy:　basic physiological considerations and immunological consequences [J]. J Urol, 2005, 174(4 Pt 1): 11831188.
21. Ure BM, Niewold TA, Bax NM, et al. Peritoneal, systemic, and distant organ inflammatory responses are reduced by a laparoscopic approach and carbon dioxide versus air [J]. Surg Endosc, 2002, 16(5): 836842.
22. Moehrlen U, Ziegler U, Boneberg E, et al. Impact of carbon dioxide versus air pneumoperitoneum on peritoneal cell migration and cell fate [J]. Surg Endosc, 2006, 20(10): 16071613.
23. Hajri A, Mutter D, Wack S, et al. Dual effect of laparoscopy on cellmediated immunity [J]. Eur Surg Res, 2000, 32(5): 261266.
24. Buunen M, Gholghesaei M, Veldkamp R, et al. Stress response to laparoscopic surgery: a review [J]. Surg Endosc, 2004, 18(7): 10221028.
25. Kuebler JF, Kos M, Jesch NK, et al. Carbon dioxide suppresses macrophage superoxide anion production independent of extracellular pH and mitochondrial activity [J]. J Pediatr Surg, 2007, 42(1): 244248.
26. Grabowski JE, Vega VL, Talamini MA, et al. Acidification enhances peritoneal macrophage phagocytic activity [J]. J Surg Res, 2008, 147(2): 206211.
  1. 1. Kitano S, Iso Y, Moriyama M, et al. Laparoscopyassisted Billroth Ⅰ gastrectomy [J]. Surg Laparosc Endosc, 1994, 4(2): 146148.
  2. 2. Kitano S, Shiraishi N, Uyama I, et al. A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan [J]. Ann Surg, 2007, 245(1): 6872.
  3. 3. Park JM, Jin SH, Lee SR, et al. Complications with laparoscopically assisted gastrectomy: multivariate analysis of 300 consecutive cases [J]. Surg Endosc, 2008, 22(10): 21332139.
  4. 4. 余佩武, 王自強, 錢鋒, 等. 腹腔鏡輔助胃癌根治術(shù)105例 [J]. 中華外科雜志, 2006, 44(19): 13031306.
  5. 5. 余佩武, 錢鋒, 羅華星, 等. 腹腔鏡胃癌根治術(shù)的臨床療效 [J]. 中華消化外科雜志, 2008, 7(1): 3840.
  6. 6. Hao YX, Zhong H, Zhang C, et al. Effects of simulated carbon dioxide and helium peumoperitoneum on proliferation and apoptosis of gastric cancer cells [J]. World J Gastroenterol, 2008, 14(14): 22412245.
  7. 7. 郝迎學(xué), 鐘華, 曾冬竹, 等. 不同壓力二氧化碳氣腹對胃癌細胞增殖運動的影響 [J]. 中華消化外科雜志, 2008, 7(1): 5658.
  8. 8. 郝迎學(xué), 鐘華, 張超, 等. 不同壓力二氧化碳氣腹對胃癌細胞遷移運動和細胞骨架的影響 [J]. 中華胃腸外科雜志, 2008, 11(5): 454457.
  9. 9. Whelan RL, Franklin M, Holubar SD, et al. Postoperative cellmediated immune response is better preserved after laparoscopic vs open colorectal resection in humans [J]. Surg Endosc, 2003, 17(6): 972978.
  10. 10. Gitzelmann CA, MendozaSagaon M, Talamini MA, et al. Cellmediated immune response is better preserved by laparoscopy than laparotomy [J]. Surgery, 2000, 127(1): 6571.
  11. 11. Aoyagi K, Kouhuji K, Yano S, et al. VEGF significance in peritoneal recurrence from gastric cancer [J]. Gastric Cancer, 2005, 8(3): 155163.
  12. 12. Kumagai K, Shimizu K, Yokoyama N, et al. Gastrointestinal cancer metastasis and lymphatic advancement [J]. Surg Today, 2010, 40(4): 301306.
  13. 13. 余佩武, 郝迎學(xué). CO2氣腹對胃腸道腫瘤侵襲轉(zhuǎn)移影響的研究現(xiàn)狀與進展 [J]. 中國普外基礎(chǔ)與臨床雜志, 2009, 16(10): 777780.
  14. 14. 劉驊, 周敏, 趙文毅, 等. 不同壓強與時程CO2氣腹對胃癌細胞黏附侵襲能力的影響 [J]. 中國普外基礎(chǔ)與臨床雜志, 2010, 17(6): 557561.
  15. 15. Nakada H, Ishida H, Hashimoto D, et al. Influence of different pneumoperitoneal pressures on tumor cell distribution rats [J]. Surg Endosc, 2005, 19(4): 563568.
  16. 16. Tang CL, Eu KW, TaiBC, et al. Randomized clinical trail of the effect of open versus laparoscopically assisted colectomy on systemic immunity in patients with colorectal cancer [J]. Br J Surg, 2001, 88(6): 801807.
  17. 17. Wichmann MW, Hüttl TP, Winter H, et al. Immunological effects of laparoscopic vs open colorectal surgery: a prospective clinical study [J]. Arch Surg, 2005, 140(7): 692697.
  18. 18. Are C, Talamini MA. Laparoscopy and malignancy [J]. J Laparoendosc Adv Surg Tech A, 2005, 15(1): 3847.
  19. 19. Nakamura T, Mitomi H, Ohtani Y, et al. Comparison of longterm outcome of laparoscopic and conventional surgery for advanced colon and rectosigmoid cancer [J]. Hepatogastroenterology, 2006, 53(69): 351353.
  20. 20. Ost MC, Tan BJ, Lee BR. Urological　laparoscopy:　basic physiological considerations and immunological consequences [J]. J Urol, 2005, 174(4 Pt 1): 11831188.
  21. 21. Ure BM, Niewold TA, Bax NM, et al. Peritoneal, systemic, and distant organ inflammatory responses are reduced by a laparoscopic approach and carbon dioxide versus air [J]. Surg Endosc, 2002, 16(5): 836842.
  22. 22. Moehrlen U, Ziegler U, Boneberg E, et al. Impact of carbon dioxide versus air pneumoperitoneum on peritoneal cell migration and cell fate [J]. Surg Endosc, 2006, 20(10): 16071613.
  23. 23. Hajri A, Mutter D, Wack S, et al. Dual effect of laparoscopy on cellmediated immunity [J]. Eur Surg Res, 2000, 32(5): 261266.
  24. 24. Buunen M, Gholghesaei M, Veldkamp R, et al. Stress response to laparoscopic surgery: a review [J]. Surg Endosc, 2004, 18(7): 10221028.
  25. 25. Kuebler JF, Kos M, Jesch NK, et al. Carbon dioxide suppresses macrophage superoxide anion production independent of extracellular pH and mitochondrial activity [J]. J Pediatr Surg, 2007, 42(1): 244248.
  26. 26. Grabowski JE, Vega VL, Talamini MA, et al. Acidification enhances peritoneal macrophage phagocytic activity [J]. J Surg Res, 2008, 147(2): 206211.