Fu K I, Fujii T, Kato S, Sano Y, Koba I, Mera K, Saito H, Yoshino T, Sugito M, Yoshida S
Dept. of Gastrointestinal Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277 8577, Japan.
Endoscopy. 2001 Aug;33(8):687-91. doi: 10.1055/s-2001-16217.
Knowledge of the exact location of colorectal lesions is necessary but difficult to establish during surgery. Thus, endoscopic tattooing has been used as an important preoperative marker for identification. Using the conventional technique, we injected tattooing agents directly into the colonic wall. However, to make sure that the tattooing agents were adequately injected into the submucosal layer, and to prevent spillage into the peritoneal cavity, we modified the conventional method and developed a new tattooing technique: using India ink with prior and subsequent injection of saline into the submucosa. The aim of this study was to retrospectively assess the clinical utility and potential complications of the above two techniques of endoscopic tattooing using India ink.
A total of 153 patients underwent laparoscopically assisted colectomy at the National Cancer Center Hospital East, Kashiwa, Chiba, Japan, between June 1994 and December 1999, and 91 patients underwent preoperative endoscopic tattooing by either the conventional or the new technique. The conventional and new techniques were used from June 1994 to December 1997 (n = 36) and from January 1998 to December 1999 (n = 55), respectively. Informed consent was obtained from all the patients.
Using the conventional technique, the exact location of the lesion was identified in 31 of 36 cases (86.1 %) during surgery. The complications of this procedure were silent local peritonitis in two patients and reactive lymph node swelling in one patient (3/36, 8.3 %). Using the new technique, in 54 of 55 cases lesions (98 %) were easily identified (p = 0.034),and in only one there was a small leakage of India ink into the peritoneal cavity (1/55; 1.8 %), no other serious complications were observed.
The results demonstrate that our new technique for endoscopic tattooing is probably better than the conventional technique for clinical use, in terms of diagnostic accuracy and safety, but this would have to be proven in a randomized comparison.
了解结直肠病变的确切位置很有必要，但在手术过程中很难确定。因此，内镜下纹身已被用作重要的术前识别标记。我们采用传统技术，将纹身剂直接注入结肠壁。然而，为确保纹身剂充分注入黏膜下层，并防止其漏入腹腔，我们改进了传统方法，开发了一种新的纹身技术：先注入印度墨水，随后再向黏膜下层注入生理盐水。本研究的目的是回顾性评估上述两种使用印度墨水的内镜纹身技术的临床实用性和潜在并发症。
1994年6月至1999年12月期间，共有153例患者在日本千叶县柏市国立癌症中心东医院接受了腹腔镜辅助结肠切除术，其中91例患者通过传统技术或新技术接受了术前内镜纹身。传统技术和新技术分别在1994年6月至1997年12月（n = 36）和1998年1月至1999年12月（n = 55）使用。所有患者均获得了知情同意。
采用传统技术时，手术中36例中有31例（86.1%）确定了病变的确切位置。该操作的并发症为2例患者出现无症状局部腹膜炎，1例患者出现反应性淋巴结肿大（3/36，8.3%）。采用新技术时，55例中有54例（98%）的病变易于识别（p = 0.034），仅1例出现少量印度墨水漏入腹腔（1/55；1.8%），未观察到其他严重并发症。
结果表明，就诊断准确性和安全性而言，我们的内镜纹身新技术在临床应用中可能优于传统技术，但这必须在随机对照研究中得到证实。
