Hiki Y, Sakuramoto S, Katada N, Shimao H
Abteilung für Chirurgie, East-Hospital, Kitasato Universität, Tokyo, Japan.
Chirurg. 2000 Oct;71(10):1193-201. doi: 10.1007/s001040051202.
The purpose of this review is to outline the laparoscopic-endoscopic procedures that we perform for early gastric cancer. These procedures were applied to 29 patients. Preoperative work-up included gastric endoscopy, barium X-ray examination, endoscopic ultrasonography, and histological examination, and surgery was performed in patients diagnosed as having mucosal gastric cancer for which endoscopic mucosal resection (EMR) was difficult. Laparoscopic wedge resection of the stomach using the lesion-lifting method, by which a wedge resection is made while pulling up the full-thickness gastric wall, was carried out in the 16 patients with lesions of the anterior wall, lesser curvature, and greater curvature of the stomach. On pathological examination of resected specimens, the surgical margin and lymphatic or venous invasion were negative in all these patients. The histological depth of the lesions was m (mucosal cancer) in 15 patients and sm1 (slight cancer infiltration into the submucosal layer) in one. This one patient later underwent gastrectomy but no lymph node metastases were found. Oral nutrition was resumed for a mean (+/- SD) of 2.9 +/- 0.8 days after operation, and the duration of hospitalization after operation was 12.3 +/- 3.4 days. The 13 patients with lesions of the posterior wall of the stomach and near the cardia or the pylorus received laparoscopic intragastric mucosal resection. Laparotomy was required in 1 of these patients due to intraoperative hemorrhage. The surgical margins were negative in all 12 patients in whom laparoscopic intragastric mucosal resection was successful. Lymphatic or venous invasion was positive in 2, both of whom had sm1 cancer lesions of both of these patients were located in the cardiac region, total gastrectomy was avoided, and careful observation is continued. Oral nutrition was resumed 4.0 +/- 1.6 days after operation, and the duration of hospitalization after operation was 12.0 +/- 3.5 days. In addition, no postoperative complication was noted after either procedure, and all patients have been recurrence free for a follow-up period of 460 months. Selected properly, these laparoscopic endoscopic procedures are considered to be curative and minimally invasive treatments for early gastric cancer.
本综述的目的是概述我们针对早期胃癌所开展的腹腔镜-内镜手术。这些手术应用于29例患者。术前检查包括胃镜检查、钡餐X线检查、内镜超声检查和组织学检查，对诊断为黏膜下胃癌且难以进行内镜黏膜切除术（EMR）的患者实施手术。对16例胃前壁、小弯侧和大弯侧有病变的患者采用病变提起法进行腹腔镜胃楔形切除术，即在提起胃全层壁的同时进行楔形切除。对切除标本进行病理检查，所有这些患者的手术切缘及淋巴或静脉侵犯均为阴性。病变的组织学深度在15例患者中为m（黏膜癌），1例为sm1（轻度癌浸润至黏膜下层）。该例患者后来接受了胃切除术，但未发现淋巴结转移。术后平均（±标准差）2.9±0.8天恢复经口营养，术后住院时间为12.3±3.4天。13例胃后壁及贲门或幽门附近有病变的患者接受了腹腔镜胃内黏膜切除术。其中1例患者因术中出血需要开腹手术。在成功进行腹腔镜胃内黏膜切除术的12例患者中，手术切缘均为阴性。2例存在淋巴或静脉侵犯，这2例患者均有sm1癌病变，且均位于贲门区域，避免了全胃切除术，继续密切观察。术后4.0±1.6天恢复经口营养，术后住院时间为12.0±3.5天。此外，两种手术术后均未出现并发症，所有患者在460个月的随访期内均无复发。如果选择得当，这些腹腔镜-内镜手术被认为是早期胃癌的根治性和微创治疗方法。
