Hoya Yoshiyuki, Yamashita Makoto, Inagaki Takuya, Yanaga Katsuhiko
Department of Surgery, Daisan Hospital, The Jikei University School of Medicine, 4-11-1, Izumihon-cho, Komae-si, Tokyo, 201-8601, Japan.
World J Surg. 2007 Aug;31(8):1602-5. doi: 10.1007/s00268-007-9115-2.
We have developed a new technique for treatment of intramucosal carcinoma which exceeds the standard indication for endoscopic mucosal resection and carcinoma invading the submucosa without lymph node metastasis that are located in the posterior wall of the stomach, which we refer to as laparoscopic intragastric full-thickness excision (LIFE) under flexible endoscopic control.
Three pigs were used for the study. Three trocars were used. The first trocar (trocar # 1) was placed in the subumbilical region to introduce the videoscope, whereas the second and third trocars (trocar # 2 and trocar # 3) were punctured percutaneously into the abdominal cavity. A straight needle with 3-0 silk suture was attached to a T-bar on the wire side and inserted into the abdominal cavity. An area adjacent to the lesion in the posterior wall of the stomach was pierced by the straight needle, which was then pulled into the stomach using the forceps of the endoscope. The T-bar, after being passed through the abdominal wall, was fixed outside the gastric wall, and trocar # 3 was repositioned in the stomach by the percutaneous transgastric route. The posterior wall of the stomach was pulled inward by the T-bar, and the lesion was removed by several excisions with laparoscopic stapling devices inserted through trocar # 3; extraction of the specimen was achieved through trocar # 3. The gastrotomy site was suture-closed using instruments positioned through trocar # 2 and trocar # 3 under laparoscopy.
Based on a feasibility study in pigs, the LIFE procedure can be performed for lesions of the posterior wall of the stomach.
我们研发了一种治疗黏膜内癌的新技术，该技术适用于超出内镜黏膜切除术标准适应证的情况，以及侵犯胃后壁黏膜下层且无淋巴结转移的癌，我们将其称为在柔性内镜控制下的腹腔镜胃内全层切除术（LIFE）。
三只猪用于该研究。使用了三个套管针。第一个套管针（套管针#1）置于脐下区域以引入视频内窥镜，而第二个和第三个套管针（套管针#2和套管针#3）经皮穿刺进入腹腔。将带有3-0丝线缝合线的直针连接到导线侧的T形杆上并插入腹腔。胃后壁病变附近的区域被直针刺穿，然后使用内窥镜钳将其拉入胃内。T形杆穿过腹壁后，固定在胃壁外，套管针#3通过经皮经胃途径重新定位在胃内。胃后壁被T形杆向内牵拉，通过经套管针#3插入的腹腔镜吻合器进行多次切除以切除病变；标本通过套管针#3取出。在腹腔镜检查下，使用通过套管针#2和套管针#3放置的器械将胃切开部位缝合关闭。
基于在猪身上的可行性研究，LIFE手术可用于治疗胃后壁病变。
