| Background:Surgical instruments are direct tools used in the surgical practice such as incision, separation, ligation, and hemostasis. The instruments may become carriers at any time because of attaching exfoliated tumor cells during the tumor resection stage. Invasiveness, growth and proliferation is the property of these exfoliated tumor cells, so they can form the secondary tumors which are same or similar to the nature of the original ones. The instruments polluted by tumor cells can lead to new implantation if these instruments do not be inactivated, and even can form carry-shed-plant chain because of reuse.At present, free-tumor technique in surgical instruments includes grouping replacement and distilled water immersion, but within the same group the instruments are still used repeatedly after grouping, as a result we cannot avoid the carrying potential during every operation. It takes a long time (5min) to inactivate tumor cells with distilled water, but the surgery operation is continuous, surgical instruments are repeated operation tools, the long time to waiting will interrupt surgical procedures. The mentioned methods has certain limitation in clinical practice because of the time, cost and effectiveness of inactivation of the tumor cells, more quicker and easier, safe and effective inactivation methods for instruments require further studies.Absolute alcohol can cause tumor cells to dehydrated and proteins to coagulation necrosis. Percutaneous absolute alcohol injections have been widely used in many solid tumor therapy such as rectal cancer, breast cancer and thyroid cancer since the first time when Sugiura applied this method to treat small hepatocellular carcinoma in1983. Many researchers suggest that percutaneous absolute alcohol injection will is an efficacious and safe therapeutic option. The inactivation of absolute alcohol on tumor cells in vitro has not been seen in the literature, and the effectiveness of absolute alcohol in inactivating exfoliated tumor cells attached to surgical instruments during operation is not clear.This study is to explore the effect of absolute alcohol in inactivating exfoliated tumor cells attached to surgical instruments, so as to provide new ideas and methods about rapidly and effectively inactivating exfoliated tumor cells of instruments during operation.Objective:1. To explore the inactivation and time-effect relationship of absolute alcohol on tumor cells in vitro.2. To investigate the effectiveness of absolute alcohol in inactivating exfoliated tumor cells attached to surgical instruments during operation.3. To explore the influence of inactivation of absolute alcohol in cleaning surgical instruments.Methods:1. The tumor cells collected from fresh tumor samples in120cases were treated with absolute alcohol for different time (5,10,15,30and60s). The number of tumor cells was detected by TCT, and the inactivation rate of absolute alcohol on tumor cells were calculated.2. The instruments used in60cases undergoing operation for primary cancer were equally randomized into two groups. The instruments in group A were cleaned with absolute alcohol and those in group B were cleaned with normal saline at first time, which were repeated for the second time of cleaning in normal saline in both groups. The number of tumor cells adhered to the instruments was detected by TCT and the positive rate of tumor cells was calculated. 3. Totally200surgical instruments which were contaminated by fresh blood were equally randomized into two groups. The instruments in group A were treated with absolute alcohol and those in group B were treated with normal saline. Residual protein on surface of surgical instruments was detected by test strips after cleaning.Results:1. The inactivation rate at15s was99.24%which was obviously higher than those at10s (95.63%) and at5s (90.98%). The inactivation rate among15s,30s and60s showed no significant difference (P>0.05). The inactivation rate is essential consistent among four types of cancer.2. The number and the positive rate of tumor cells after cleaned once were less in group A than that in group B [(0.12±0.09) cells vs (3.05±1.40)cells and4.67%vs63.33%](P<0.01). The positive rate after cleaned twice was significantly lower in group A (1.67%) than that in group B (26.67%)(P<0.01).3. No significant difference of positive rate of residual protein was observed between two groups (P>0.05), and no significant difference was found between two types of instruments (P>0.05).Conclusion:1. The absolute alcohol can inactivate tumor cells in vitro quickly and effectively. The inactivation effect gradually enhances with the extension of the action time within15s and goes to stabilization after15s.2. Cleaning the instruments with absolute alcohol can quickly and effectively inactivate tumor cells and decrease the positive rate during operation of hepatic cancer. Each instrument can be treated immediately, blocking every possible of carrying, to realize the process control of the free-tumor technique.3. Inactivation of absolute alcohol does not increase the cleaning difficulty and has no impact on the effect of surgical instruments cleaning. 4. Absolute alcohol should be used in inactivating exfoliated tumor cells of instruments, to realize the process control of instruments during operation and to provide reference to the development of guidance and standards. |
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