Hyung W J, Lim J S, Cheong J H, Kim J, Choi S H, Song S Y, Noh S H
Department of Surgery, College of Medicine, Yonsei University, Seoul, 120-752, Korea.
Surg Endosc. 2005 Oct;19(10):1353-7. doi: 10.1007/s00464-004-8196-3. Epub 2005 May 26.
During laparoscopic-assisted gastrectomy, it is impossible to identify early gastric cancer (EGC) lesions; therefore, a precise localization technique is needed. In this study, we used laparoscopic ultrasonography (LUS) after endoscopic clipping as a method of localizing EGC and evaluated the effectiveness of this method.
A prospective study of 17 patients who had undergone laparoscopic-assisted gastrectomy was performed. Three endoscopic clips were applied just proximal to the tumor during the preoperative endoscopy. The applied clips were detected from the serosal side of the stomach using LUS. The serosal surface of the lesion was marked with dye.
In all patients, endoscopic clips were applied proximal to the lesion without complications, and the applied clips were confirmed by plain abdominal radiography. The clips were successfully detected by LUS in all patients. In the resected specimen, the serosal surface, marked with dye, was always just above the clips in the anterior wall or on the anterior wall opposite the clips applied in the posterior wall. The mean detection time was 4.7 min (range, 2-8). With this procedure, two patients underwent total gastrectomy and 15 patients underwent distal subtotal gastrectomy with gastroduodenostomy or gastrojejunostomy. Histological examination confirmed that the resection margins were tumor free in all patients. There was no operative morbidity related to the LUS procedure.
Using LUS to detect endoscopic clips is an easy, safe, and accurate method to localize EGC lesions in laparoscopic-assisted gastrectomy.
在腹腔镜辅助胃切除术期间，无法识别早期胃癌（EGC）病变；因此，需要一种精确的定位技术。在本研究中，我们将内镜夹闭术后的腹腔镜超声检查（LUS）作为定位EGC的方法，并评估了该方法的有效性。
对17例行腹腔镜辅助胃切除术的患者进行了一项前瞻性研究。在术前内镜检查期间，在肿瘤近端仅应用三个内镜夹。使用LUS从胃浆膜侧检测所应用的夹子。用染料标记病变的浆膜表面。
所有患者均在病变近端应用内镜夹且无并发症，所应用的夹子通过腹部平片得以确认。所有患者均通过LUS成功检测到夹子。在切除的标本中，用染料标记的浆膜表面总是在前壁夹子的正上方或在后壁应用夹子相对的前壁上。平均检测时间为4.7分钟（范围2-8分钟）。通过该操作，2例患者接受了全胃切除术，15例患者接受了远端次全胃切除术并进行了胃十二指肠吻合术或胃空肠吻合术。组织学检查证实所有患者的切除边缘均无肿瘤。没有与LUS操作相关的手术并发症。
在腹腔镜辅助胃切除术中，使用LUS检测内镜夹是一种简单、安全且准确的定位EGC病变的方法。
