Montorsi M, Opocher E, Santambrogio R, Bianchi P, Faranda C, Arcidiacono P, Passoni G R, Cosentino F
Istituto di Chirurgia Generale e Oncologia Chirurgica, Ospedale Maggiore Policlinico IRCCS, Università di Milano, Milan, Italy.
Dis Colon Rectum. 1999 Jun;42(6):819-22. doi: 10.1007/BF02236943.
Small colonic tumor localization and correct extension of colonic resection is critical in laparoscopic surgery. Currently used techniques are sometimes inconclusive and may carry some morbidity. We describe an original method of small tumor localization during laparoscopic colorectal operations through the use of preoperative clip applications by colonoscopy and intraoperative ultrasound of the colon.
Eight patients with small colonic lesions necessitating preoperative marking were included into this study. A two-step technique was used. Before the operation two metal clips were endoscopically applied proximally and distally to the lesion site. At surgery an intraoperative ultrasound examination of the colon or rectum surface was performed to localize the clips. Subsequent laparoscopic colon resection was performed.
Endoscopic metallic clips were easily applied around the lesion in all cases without complications. No dislodgement of clips was documented. At surgery laparoscopic ultrasound visualized the clips in all cases. The examination took between 5 and 17 minutes with no specific morbidity. The lesions with the surrounding clips were always found in the resected specimen.
Endoscopic metal clipping and intraoperative laparoscopic ultrasound proved to be an easy, safe, and accurate technique in locating small colonic tumors.
在腹腔镜手术中，小的结肠肿瘤定位及结肠切除范围的正确界定至关重要。目前使用的技术有时并不确定，且可能会带来一些并发症。我们描述了一种在腹腔镜结直肠手术中定位小肿瘤的原始方法，即通过结肠镜术前夹闭应用及术中结肠超声检查来实现。
本研究纳入了8例需要术前标记的小结肠病变患者。采用两步法。手术前，通过内镜在病变部位的近端和远端夹闭两个金属夹。手术时，对结肠或直肠表面进行术中超声检查以定位夹子。随后进行腹腔镜结肠切除术。
在所有病例中，内镜金属夹均能轻松地夹闭在病变周围，无并发症发生。未记录到夹子移位。手术时，腹腔镜超声在所有病例中均能看到夹子。检查耗时5至17分钟，无特殊并发症。切除标本中总能发现带有周围夹子的病变。
内镜金属夹闭及术中腹腔镜超声检查被证明是一种定位小结肠肿瘤的简便、安全且准确的技术。
