Grant-in-Aid for Scientific Research (B).
|Research Institution||Oita Medical University|
KITANO Seigo Oita Medical University, Dept. of Surg. 1, Professor, 医学部, 教授 (90169871)
BANDOH Toshio Oita Medical University, Dept.of Surg. 1, Assistant Professor, 医学部, 助手 (80284793)
SHIRAISHI Norio Oita Medical University, Dept.of Surg. 1, Assistant Professor, 医学部, 講師 (20271132)
ADACHI Yousuke Oita Medical University, Dept.of Surg. 1, Assistant Professor, 医学部, 講師 (90221043)
|Project Fiscal Year
1998 – 1999
Completed(Fiscal Year 1999)
|Budget Amount *help
¥11,400,000 (Direct Cost : ¥11,400,000)
Fiscal Year 1999 : ¥2,800,000 (Direct Cost : ¥2,800,000)
Fiscal Year 1998 : ¥8,600,000 (Direct Cost : ¥8,600,000)
|Keywords||laparoscopic surgery / CO2 pneumoperitoneum / cancer / growth / metastasis / 腹腔鏡下手術 / 炭酸ガス気腹 / 循環動態 / 癌の増殖 / 癌の進展 / 癌の転移性 / 血行動態 / サイトカイン / 血行性転移 / 腫瘍増殖|
Recently, laparoscopic surgery has been applied for gastro-intestinal malignancies. To clarify the effect of the CO2 pneumoperitoneum after laparoscopic procedures on the growth, invasiveness and metastasis of cancers, we have examined in this study.
1. The effect of CO2 pneumoperitoneum on physiological function.
(1) Circulation system (in porcine or rat model);
1.Venous return was decreased because of increasing of the peripheral vessel resistance.
2.The cardiac out put and renal flow were less decreased in the abdominal wall lifting groups than in the pneumoperitoneum groups in clinical setting.
3.The asidosis was observed during the peritoneum. This was depend not on the species of the gas such as CO2, Helium, and Air, but on the intraperitoneal pressure.
(2) The effect on the liver and renal function (in rat model);
1.The level of vasopressin in the serum was increased and the oliguria was occurred during CO2 pneumoperitoneum. The antagonist against the vasopressin inhi
bited these effect.
2. As the CO2 pneumoperitoneum made the portal flow was decreased, and hepatic arterial flow was increased, The total hepatic flow was not remarkably changed by CO2 pneumoperitoneum.
(3) The effect on immunological function (in rat model);
The production of cytokines in the systemic and the intraabdominal cavity was suppressed by CO2 pneumoperitoneum.
2, The effect on the growth and progression of malignancy.
(1) A murine pneumoperitoneum model w as established.
(2) The effect on the morphological change of the mesothelial cells by scanning electro microscopy; The CO2 pneumoperitoneum induced the mesothelial cells to change to the cubic formation.
(3) The effect on the intraperitoneal dissemination of cancers was shown to be enhanced by CO2 pneumoperitoneum as well as by the laparotomy.
(4) The number of the lung metastasis of the cancer cells injected into tail vein was less after the pneumoperitoneum in compared with after the laparotomy.
(5) The pneumoperitoneum induced Hyarulonic acid in the abdominal cavity after CO2 pneumoperitoneum.
(6) Exogenous Hyarulonic acid injected into abdominal cavity enhanced the formation of port site recurrence.
(7) In the inhibition study using antibody against integrin or CD44, port site recurrence was inhibited.
This study shows the CO2 pneumoperitoneum after laparoscopic cancer surgery has some effects on circulation system, renal function, immunological response and tumor growth. Though, these effects seem to be almost not clitical, more studies are needed to perform safely laparoscopic surgery for cancers. Less