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

自1987年Mouret完成世界首例腹腔鏡膽囊切除術(shù)以來,隨著外科醫(yī)生手術(shù)技術(shù)的不斷提高和腹腔鏡器械的逐漸改進,腹腔鏡微創(chuàng)技術(shù)的應(yīng)用范圍越來越廣泛,以腹腔鏡為代表的微創(chuàng)外科已經(jīng)成為21世紀外科發(fā)展的方向之一,其對胃腸道惡性腫瘤根治的可行性和手術(shù)安全性已經(jīng)得到認可。已有多項RCT研究顯示,腹腔鏡結(jié)直腸癌手術(shù)與開腹手術(shù)具有相當(dāng)?shù)慕⑦h期療效,美國結(jié)直腸癌外科醫(yī)師協(xié)會已將其列為治療結(jié)直腸癌的標準手術(shù)方式之一。近年來,腹腔鏡在胃癌根治術(shù)中的應(yīng)用已逐漸由早期胃癌擴展到進展期胃癌,并取得了與開腹手術(shù)相當(dāng)?shù)慕?、中期療效。但是人們對CO2 氣腹是否有利于胃腸道腫瘤的侵襲、轉(zhuǎn)移一直心存疑慮,隨之一些有關(guān)腹腔鏡技術(shù)中不同種類、不同壓力的氣腹與胃腸道腫瘤侵襲、轉(zhuǎn)移關(guān)系的研究報道相繼出現(xiàn),不同學(xué)者報道結(jié)果有較大差異,有些學(xué)者認為CO2氣腹有利于胃腸道腫瘤的侵襲、轉(zhuǎn)移; 而有些學(xué)者卻認為CO2氣腹對胃腸道腫瘤的侵襲、轉(zhuǎn)移無顯著影響。..................

引用本文: 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. 中國普外基礎(chǔ)與臨床雜志, 2009, 16(10): 777-780. doi: 復(fù)制

1. Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer [J]. N Engl J Med, 2004; 350(20): 2050-2059.
2. Braga M, Frasson M, Vignali A, et al. Laparoscopic vs. open colectomy in cancer patients: long-term complications, quality of life, and survival [J]. Dis Colon Rectum, 2005; 48(12): 2217-2223.
3. 鄭民華, 蔡景理, 陸愛國, 等. 腹腔鏡手術(shù)治療結(jié)直腸癌安全性的臨床研究 [J]. 外科理論與實踐, 2003; 8(5): 361-364.
4. 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.
5. Memon MA, Khan S, Yunus RM, et al. Meta-analysis of laparoscopic and open distal gastrectomy for gastric carcinoma [J]. Surg Endosc, 2008; 22(8): 1781-1789.
6. Gutt CN, Kim ZG, Hollander D, et al. CO2 environment influences the growth of cultured human cancer cells dependent on insufflation pressure [J]. Surg Endosc, 2001; 15(3): 314-318.
7. Wittich P, Steyerberg EW, Simons SH, et al. Intraperitoneal tumor growth is influenced by pressure of carbon dioxide pneumoperitoneum [J]. Surg Endosc, 2000; 14(9): 817-819.
8. 石彥, 郝迎學(xué), 雷曉, 等. 模擬CO2氣腹對人胃癌MKN-45細胞增殖和細胞周期的影響 [J]. 第三軍醫(yī)大學(xué)學(xué)報, 2007; 29(23): 2274-2276.
9. 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.
10. Tomita H, Marcello PW, Milsom JW, et al. CO2 pneumoperitoneum does not enhance tumor growth and metastasis: study of a rat cecal wall inoculation model [J]. Dis Colon Rectum, 2001; 44(9): 1297-1301.
11. 鄭民華, 馬君俊, 馮波, 等. 不同壓強持續(xù)性CO2對結(jié)腸癌細胞侵襲轉(zhuǎn)移的影響 [J]. 中華實驗外科雜志, 2005; 22(10): 1164-1166.
12. 郝迎學(xué), 鐘華, 張超, 等. 體外模擬氣腹環(huán)境對胃癌細胞增殖凋亡的影響 [J]. 中國微創(chuàng)外科雜志, 2008; 8(6): 552-555.
13. 郝迎學(xué), 鐘華, 曾冬竹, 等. 缺氧誘導(dǎo)因子1α對CO2氣腹環(huán)境下人胃癌細胞凋亡的影響 [J]. 中華普通外科雜志, 2008; 43(6): 460-463.
14. Kim ZG, Mehl C, Lorenz M, et al. Impact of laparoscopic CO2-insufflation on tumor-associated molecules in cultured colorectal cancer cells [J]. Surg Endosc, 2002; 16(8): 1182-1186.
15. Paraskeva PA. Hypoxic pneumoperitoneum initiates the metastatic cascade in colon cancer cells [J]. Br J Surg, 2000; 87(suppl 1): 3.
16. 鄭民華, 馬君俊, 馮波, 等. CO2氣腹對結(jié)腸癌細胞粘附能力影響及其與粘附分子的關(guān)系 [J]. 中國實用外科雜志, 2005; 25(11): 668-670.
17. 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.
18. 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.
19. 石彥, 錢鋒, 郝迎學(xué), 等. 二氧化碳氣腹對胃癌MKN-45細胞侵襲能力的影響 [J]. 中華消化外科雜志, 2007; 6(6): 449-451.
20. Wildbrett P, Oh A, Naundorf D, et al. Impact of laparoscopic gases on peritoneal microenvironment and essential parameters of cell function [J]. Surg Endosc, 2003; 17(1): 78-82.
21. Duerr FM, Twedt DC, Monnet E. Changes in pH of peritoneal fluid associated with carbon dioxide insufflation during laparoscopic surgery in dogs [J]. Am J Vet Res, 2008; 69(2): 298-301.
22. Volz J, Kster S, Spacek Z, et al. Characteristic alterations of the peritoneum after carbon dioxide pneumoperitoneum [J]. Surg Endosc, 1999; 13(6): 611-614.
23. Jacobi CA, Sabat R, Bhm B, et al. Pneumoperitoneum with carbon dioxide stimulates growth of malignant colonic cells [J]. Surgery, 1997; 121(1): 72-78.
24. Rofe AM, Bourgeois CS, Coyle P. Beneficial effects of endotoxin treatment on metabolism in tumour-bearing rats [J]. Immunol Cell Biol, 1992; 70(Pt 1): 1-7.
25. Jackson PG, Evans SR. Intraperitoneal macrophages and tu-mor immunity: A review [J]. J Surg Oncol, 2000; 75(2): 146-154.
26. West MA, Hackam DJ, Baker J, et al. Mechanism of decreased in vitro murine macrophage cytokine release after exposure to carbon dioxide: relevance to laparoscopic surgery [J]. Ann Surg, 1997; 226(2): 179-190.
27. 羅華星, 余佩武, 王自強, 等. 腹腔鏡輔助下胃癌根治術(shù)對機體免疫功能的影響 [J]. 第三軍醫(yī)大學(xué)學(xué)報, 2005; 27(9): 910-912.
28. Suematsu T, Hirabayashi Y, Shiraishi N, et al. Morphology of the murine peritoneum after pneumoperitoneum vs laparotomy [J]. Surg Endosc, 2001; 15(9): 954-958.
29. 劉彥, 侯慶香. 二氧化碳氣腹腹腔鏡手術(shù)對人體腹膜形態(tài)學(xué)的影響 [J]. 中華醫(yī)學(xué)雜志, 2006; 86(3): 164-166.
30. 郝迎學(xué), 余佩武, 錢鋒, 等. 腹腔鏡胃癌根治術(shù)后腹腔游離癌細胞的變化及意義 [J]. 中華外科雜志, 2008; 46(23): 1748-1749.
31. 青廉, 余佩武, 王自強, 等. 腹腔鏡胃癌根治術(shù)后腹腔沖洗液CEA mRNA的變化和意義 [J]. 消化外科, 2006; 5(2): 102-104.
32. Neuhaus SJ, Watson DI, Ellis T, et al. Influence of cytotoxic agents on intraperitoneal tumor implantation after laparoscopy [J]. Dis Colon Rectum, 1999; 42(1): 10-15.
33. Peng Y, Zheng M, Feng B, et al. Hyperthermic CO2 pneumoperitoneum induces apoptosis in human colon cancer cells through Bax-associated mitochondrial pathway [J]. Oncol Rep, 2008; 19(1): 73-79.
  1. 1. Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer [J]. N Engl J Med, 2004; 350(20): 2050-2059.
  2. 2. Braga M, Frasson M, Vignali A, et al. Laparoscopic vs. open colectomy in cancer patients: long-term complications, quality of life, and survival [J]. Dis Colon Rectum, 2005; 48(12): 2217-2223.
  3. 3. 鄭民華, 蔡景理, 陸愛國, 等. 腹腔鏡手術(shù)治療結(jié)直腸癌安全性的臨床研究 [J]. 外科理論與實踐, 2003; 8(5): 361-364.
  4. 4. 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.
  5. 5. Memon MA, Khan S, Yunus RM, et al. Meta-analysis of laparoscopic and open distal gastrectomy for gastric carcinoma [J]. Surg Endosc, 2008; 22(8): 1781-1789.
  6. 6. Gutt CN, Kim ZG, Hollander D, et al. CO2 environment influences the growth of cultured human cancer cells dependent on insufflation pressure [J]. Surg Endosc, 2001; 15(3): 314-318.
  7. 7. Wittich P, Steyerberg EW, Simons SH, et al. Intraperitoneal tumor growth is influenced by pressure of carbon dioxide pneumoperitoneum [J]. Surg Endosc, 2000; 14(9): 817-819.
  8. 8. 石彥, 郝迎學(xué), 雷曉, 等. 模擬CO2氣腹對人胃癌MKN-45細胞增殖和細胞周期的影響 [J]. 第三軍醫(yī)大學(xué)學(xué)報, 2007; 29(23): 2274-2276.
  9. 9. 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.
  10. 10. Tomita H, Marcello PW, Milsom JW, et al. CO2 pneumoperitoneum does not enhance tumor growth and metastasis: study of a rat cecal wall inoculation model [J]. Dis Colon Rectum, 2001; 44(9): 1297-1301.
  11. 11. 鄭民華, 馬君俊, 馮波, 等. 不同壓強持續(xù)性CO2對結(jié)腸癌細胞侵襲轉(zhuǎn)移的影響 [J]. 中華實驗外科雜志, 2005; 22(10): 1164-1166.
  12. 12. 郝迎學(xué), 鐘華, 張超, 等. 體外模擬氣腹環(huán)境對胃癌細胞增殖凋亡的影響 [J]. 中國微創(chuàng)外科雜志, 2008; 8(6): 552-555.
  13. 13. 郝迎學(xué), 鐘華, 曾冬竹, 等. 缺氧誘導(dǎo)因子1α對CO2氣腹環(huán)境下人胃癌細胞凋亡的影響 [J]. 中華普通外科雜志, 2008; 43(6): 460-463.
  14. 14. Kim ZG, Mehl C, Lorenz M, et al. Impact of laparoscopic CO2-insufflation on tumor-associated molecules in cultured colorectal cancer cells [J]. Surg Endosc, 2002; 16(8): 1182-1186.
  15. 15. Paraskeva PA. Hypoxic pneumoperitoneum initiates the metastatic cascade in colon cancer cells [J]. Br J Surg, 2000; 87(suppl 1): 3.
  16. 16. 鄭民華, 馬君俊, 馮波, 等. CO2氣腹對結(jié)腸癌細胞粘附能力影響及其與粘附分子的關(guān)系 [J]. 中國實用外科雜志, 2005; 25(11): 668-670.
  17. 17. 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.
  18. 18. 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.
  19. 19. 石彥, 錢鋒, 郝迎學(xué), 等. 二氧化碳氣腹對胃癌MKN-45細胞侵襲能力的影響 [J]. 中華消化外科雜志, 2007; 6(6): 449-451.
  20. 20. Wildbrett P, Oh A, Naundorf D, et al. Impact of laparoscopic gases on peritoneal microenvironment and essential parameters of cell function [J]. Surg Endosc, 2003; 17(1): 78-82.
  21. 21. Duerr FM, Twedt DC, Monnet E. Changes in pH of peritoneal fluid associated with carbon dioxide insufflation during laparoscopic surgery in dogs [J]. Am J Vet Res, 2008; 69(2): 298-301.
  22. 22. Volz J, Kster S, Spacek Z, et al. Characteristic alterations of the peritoneum after carbon dioxide pneumoperitoneum [J]. Surg Endosc, 1999; 13(6): 611-614.
  23. 23. Jacobi CA, Sabat R, Bhm B, et al. Pneumoperitoneum with carbon dioxide stimulates growth of malignant colonic cells [J]. Surgery, 1997; 121(1): 72-78.
  24. 24. Rofe AM, Bourgeois CS, Coyle P. Beneficial effects of endotoxin treatment on metabolism in tumour-bearing rats [J]. Immunol Cell Biol, 1992; 70(Pt 1): 1-7.
  25. 25. Jackson PG, Evans SR. Intraperitoneal macrophages and tu-mor immunity: A review [J]. J Surg Oncol, 2000; 75(2): 146-154.
  26. 26. West MA, Hackam DJ, Baker J, et al. Mechanism of decreased in vitro murine macrophage cytokine release after exposure to carbon dioxide: relevance to laparoscopic surgery [J]. Ann Surg, 1997; 226(2): 179-190.
  27. 27. 羅華星, 余佩武, 王自強, 等. 腹腔鏡輔助下胃癌根治術(shù)對機體免疫功能的影響 [J]. 第三軍醫(yī)大學(xué)學(xué)報, 2005; 27(9): 910-912.
  28. 28. Suematsu T, Hirabayashi Y, Shiraishi N, et al. Morphology of the murine peritoneum after pneumoperitoneum vs laparotomy [J]. Surg Endosc, 2001; 15(9): 954-958.
  29. 29. 劉彥, 侯慶香. 二氧化碳氣腹腹腔鏡手術(shù)對人體腹膜形態(tài)學(xué)的影響 [J]. 中華醫(yī)學(xué)雜志, 2006; 86(3): 164-166.
  30. 30. 郝迎學(xué), 余佩武, 錢鋒, 等. 腹腔鏡胃癌根治術(shù)后腹腔游離癌細胞的變化及意義 [J]. 中華外科雜志, 2008; 46(23): 1748-1749.
  31. 31. 青廉, 余佩武, 王自強, 等. 腹腔鏡胃癌根治術(shù)后腹腔沖洗液CEA mRNA的變化和意義 [J]. 消化外科, 2006; 5(2): 102-104.
  32. 32. Neuhaus SJ, Watson DI, Ellis T, et al. Influence of cytotoxic agents on intraperitoneal tumor implantation after laparoscopy [J]. Dis Colon Rectum, 1999; 42(1): 10-15.
  33. 33. Peng Y, Zheng M, Feng B, et al. Hyperthermic CO2 pneumoperitoneum induces apoptosis in human colon cancer cells through Bax-associated mitochondrial pathway [J]. Oncol Rep, 2008; 19(1): 73-79.