Cho Yong Beom, Lee Woo Yong, Yun Hae Ran, Lee Won Suk, Yun Seong Hyeon, Chun Ho-Kyung
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Ilwon-dong 50, Gangnam-gu, Seoul 135-710, South Korea.
World J Surg. 2007 Jul;31(7):1491-5. doi: 10.1007/s00268-007-9082-7. Epub 2007 May 30.
Because palpating colonic tumors during laparoscopy is impossible, the precise location of a tumor must be identified before operation. The aim of this study was to evaluate the accuracy of various diagnostic methods that are used to localize colorectal tumors and to propose an adequate localization protocol for laparoscopic colorectal surgery.
A total of 310 patients underwent laparoscopy-assisted colectomy between April 2000 and March 2006. We investigated if the locations of the tumors that were estimated preoperatively were consistent with the actual locations according to the operation.
All the tumors were correctly localized and resected. Altogether, 203 patients had complete endoscopic reports available. Colonoscopy was inaccurate for tumor localization in 23 cases (11.3%). In total, 104 patients (33.5%) underwent barium enema; five tumors (4.8%) were not visualized, and three tumors were incorrectly localized. Another group of 94 patients (30.3%) underwent computed tomography (CT) colonography, which identified 91 of 94 lesions (96.8%). Finally, 96 patients (31.0%) underwent endoscopic tattooing; 2 patients (2.1%) did not have tattoos visualized laparoscopically and required intraoperative colonoscopy to localize their lesions during resection. Dye spillage was found in six patients intraoperatively, but only one patient experienced clinical symptoms. Intraoperative colonoscopy was performed in four patients; two of the four were followed by endoscopic tattooing, and the other two underwent intraoperative colonoscopy for localization. All lesions were correctly localized by intraoperative colonoscopy. The accuracy of tumor localization was as follows: colonoscopy (180/203, 88.7%), barium enema (97/104, 93.3%), CT colonography (89/94, 94.7%), endoscopic tattooing (94/96, 97.9%), and intraoperative colonoscopy (4/4, 100%).
With a combination of methods, localization of tumors for laparoscopic surgery did not seem very different from that during open surgery. Preoperative endoscopic tattooing is a safe, highly effective method for localization. In the case of tattoo failure, intraoperative colonoscopy can be used for accurate localization.
由于在腹腔镜检查过程中无法触诊结肠肿瘤，因此必须在手术前确定肿瘤的精确位置。本研究的目的是评估用于定位结直肠肿瘤的各种诊断方法的准确性，并为腹腔镜结直肠手术提出适当的定位方案。
2000年4月至2006年3月期间，共有310例患者接受了腹腔镜辅助结肠切除术。我们根据手术情况调查术前估计的肿瘤位置是否与实际位置一致。
所有肿瘤均被正确定位并切除。共有203例患者有完整的内镜报告。结肠镜检查在23例（11.3%）患者中肿瘤定位不准确。总共有104例患者（33.5%）接受了钡灌肠检查；5例肿瘤（4.8%）未显影，3例肿瘤定位错误。另一组94例患者（30.3%）接受了计算机断层扫描（CT）结肠成像检查，其中94处病变中的91处（96.8%）被识别出来。最后，96例患者（31.0%）接受了内镜下纹身；2例患者（2.1%）在腹腔镜检查中未见到纹身，在切除过程中需要术中结肠镜检查来定位病变。术中发现6例患者有染料外溢，但只有1例患者出现临床症状。4例患者进行了术中结肠镜检查；其中2例随后进行了内镜下纹身，另外2例进行术中结肠镜检查以定位。所有病变均通过术中结肠镜检查正确定位。肿瘤定位的准确性如下：结肠镜检查（180/203，88.7%）、钡灌肠检查（97/104，93.3%）、CT结肠成像检查（89/94，94.7%）、内镜下纹身（94/96，97.9%）和术中结肠镜检查（4/4，100%）。
通过多种方法结合，腹腔镜手术中肿瘤的定位与开放手术中的定位似乎没有太大差异。术前内镜下纹身是一种安全、高效的定位方法。在纹身失败的情况下，术中结肠镜检查可用于准确的定位。
