The effect of immune enhancement and suppression on the development of laparoscopic port site metastases
The effect of immune enhancement and suppression on the development of laparoscopic port site metastases
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DOI：
10.1007/s004640000157
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发表时间：
2000-05-01
期刊：
影响因子：
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通讯作者：
Jamieson, GG
中科院分区：
文献类型：
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作者：
Neuhaus, SJ;Watson, DI;Jamieson, GG
背景资料：最近的临床病例报告和实验研究表明，腹腔镜癌症手术与肿瘤扩散到腹壁伤口的风险增加有关。虽然最初认为该问题的病因与伤口的机械污染有关，但现在认识到还有其他促成因素，包括腹膜腔内的免疫功能紊乱。为了进一步研究这个问题，我们评估了免疫调节的效果，在一个建立的腹腔镜癌症model.Methods：18免疫能力同系大鼠进行了调制他们的免疫系统，随后18小时后，腹腔镜手术的腺癌细胞悬浮液进入腹腔。大鼠随机分配接受全身性环孢素（免疫抑制剂），腹腔内毒素（免疫增强剂），或没有代理（对照）。结果：环孢素对实验结果无明显影响，但对肿瘤生长有一定的影响（p = 0.008）和输液港部位转移（p < 0.0001）在以下给药后较不常见：腹腔内毒素。这项研究的结果表明，免疫系统在港口网站转移的发生中发挥作用。然而，内毒素在接受腹腔镜癌症手术的患者中的预防作用仍然是推测性的。
Background: Recent clinical case reports and experimental studies have suggested that laparoscopic cancer surgery is associated with an increased risk of tumor spread to abdominal wall wounds. While the etiology of this problem was initially believed to be related to mechanical contamination of wounds, it is now recognized that there are other contributory factors, including disturbed immune function within the peritoneal cavity. To investigate this question further, we evaluated the effect of immune modulation within an established laparoscopic cancer model.Methods: Eighteen immune-competent syngeneic rats underwent modulation of their immune system, followed 18 h later by laparoscopy with the introduction of a suspension of adenocarcinoma cells into the peritoneal cavity. Rats were randomly allocated to receive either systemic cyclosporin (immune suppresser), intraperitoneal endotoxin (immune enhancer), or no agent (controls). Seven days later, all rats were killed and their peritoneal cavity was inspected for tumor implantation and port site metastases.Results: Cyclosporin did not influence the study outcome, but tumor growth (p = 0.008) and port site metastases (p < 0.0001) were less common following the administration of: intraperitoneal endotoxin.Conclusion: The results of this study suggest that the immune system plays a role in the genesis of port site metastases. A preventive role for endotoxin in patients undergoing laparoscopic cancer surgery, however, remains speculative.