Matsui Hideo, Okamoto Yuichi, Nabeshima Kazuhito, Kondoh Yasumasa, Ogoshi Kyoji, Makuuchi Hiroyasu
Department of Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, Japan.
Surg Endosc. 2009 May;23(5):1146-9. doi: 10.1007/s00464-009-0354-1. Epub 2009 Mar 4.
Preoperative endoscopic tattooing or clipping is generally used to delineate the tumor-free margin in surgery for early gastric cancer. However, it is sometimes difficult to identify the line of resection during laparoscopic gastrectomy.
Between June 2003 and February 2008, we performed a total of 12 endoscopy-assisted gastric resections during laparoscopic gastrectomy for cancer, including four cases of high distal gastrectomy and eight cases of proximal gastrectomy. In the laparoscopic high distal gastrectomy cases, a surgeon performed transduodenal endoscopy to identify the clips before gastric resection. For totally laparoscopic proximal gastrectomy, an endoscopist performed transoral endoscopy to identify the clips placed in the distal margin of the lesion and to facilitate intracorporeal anastomosis.
In all cases, we were able to observe clips as well as the primary lesion. Gastric resection was successfully performed with no positive margin. In the high distal gastrectomy group (n = 4), proximal and distal margins were 19.5 +/- 2.1 (range, 10-35) mm and 1,185 +/- 190.9 (range, 850-1,320) mm, respectively. In the proximal gastrectomy group (n = 8), proximal and distal margins were 21.3 +/- 7.1 (range, 5-38) mm and 47.5 +/- 3.5 (range, 15-75) mm, respectively. The intracorporeal side-to-side anastomosis during proximal gastrectomy was successfully performed using an endolinear stapler.
Endoscopy-assisted gastric resection is a safe and reliable procedure for tumor clearance during laparoscopic high distal or proximal gastrectomy.
术前内镜下纹身或夹闭术通常用于在早期胃癌手术中勾勒出无肿瘤边缘。然而，在腹腔镜胃切除术中有时难以确定切除线。
2003年6月至2008年2月期间，我们在腹腔镜胃癌切除术中总共进行了12例内镜辅助胃切除术，包括4例高位远端胃切除术和8例近端胃切除术。在腹腔镜高位远端胃切除术病例中，外科医生在胃切除术前进行经十二指肠内镜检查以识别夹子。对于完全腹腔镜近端胃切除术，内镜医生进行经口内镜检查以识别放置在病变远端边缘的夹子并促进体内吻合。
在所有病例中，我们都能够观察到夹子以及原发病变。成功进行了胃切除术，切缘无阳性。在高位远端胃切除术组（n = 4）中，近端和远端切缘分别为19.5±2.1（范围，10 - 35）mm和1,185±190.9（范围，850 - 1,320）mm。在近端胃切除术组（n = 8）中，近端和远端切缘分别为21.3±7.1（范围，5 - 38）mm和47.5±3.5（范围，15 - 75）mm。使用线性吻合器成功进行了近端胃切除术中的体内侧侧吻合。
内镜辅助胃切除术是腹腔镜高位远端或近端胃切除术中肿瘤清除的一种安全可靠的手术方法。
