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穿刺孔转移:审视腹腔镜肿瘤外科的安全性
Port-site metastases: Considerations for laparoscopic oncologic surgeries
文章发布日期:2013年02月01日  来源:  作者:刘全达,许小亚 ,周宁新  点击次数:2228次  下载次数:511次

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【摘要】:穿刺孔转移是腹腔镜肿瘤外科的少见事件,发生率约为0.6%~21%,和传统开放手术切口转移率相当。穿刺孔转移的发生预示预后不良,但孤立性穿刺孔转移并不绝对代表晚期疾病状态。早期穿刺孔转移高发生率引发了针对腹腔镜肿瘤外科的极大关注。临床和实验资料表明,穿刺孔转移的发生虽然是肿瘤生物学等多因素的结果,但主要与腹腔镜外科经验不足和过多肿瘤处理密切相关。因此,严格遵守外科肿瘤原则和提高外科经验是预防穿刺孔转移发生的最关键因素。
【Abstract】:Although rare, port-site metastasis (PSM) following laparoscopic oncologic surgery has negative impact on patient prognosis and survival. While PSM occurrence has been associated with advanced disease status in some studies, its etiology and pathogenesis in various oncologic and surgical situations remain to be fully understood. Several biologic- and technique-related factors have been implicated in development of PSMs, suggesting a multifactorial process. In this review of the collective PSM case reports and experimental investigations in the literature, we discuss the putative etiologic factors and their potential mechanisms to gain a better understanding of this detrimental consequence of an otherwise beneficial (minimally invasive) technique. In particular, the roles of tumor-related factors (such as invasiveness), wound-related factors (such as tumor cell contamination acting as tumor seeding), gas-related conditions (such as hypoxia and pressure), immunomodulatory factors (such as stimulation/suppression of the inflammatory response), and surgery-related factors (such as the surgeon's skill) are detailed. This information is intended to not only improve our understanding of the causes of PSMs, but to promote the safety and efficacy of the application of laparoscopy in oncologic surgery.
【关键字】:腹腔镜检查;肿瘤外科;穿刺孔转移;肿瘤学
【Key words】:laparoscopy; oncologic surgery; port-site metastasis; oncology
【引证本文】:

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