Department of Gastroenterological Surgery, Oita University Faculty of Medicine, Oita, Japan.
Gastrointest Endosc. 2010 Aug;72(2):438-43. doi: 10.1016/j.gie.2010.03.1066. Epub 2010 Jun 11.
As endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) increases, increasing numbers of patients require additional gastrectomy with lymph node dissection after noncurative ESD. ESD may cause intra-abdominal adhesions, making additional laparoscopic gastrectomy technically difficult.
To assess the relation of the presence of intra-abdominal adhesions and ESD treatment to allow safe laparoscopic gastrectomy.
Case series from a retrospective review of additional gastrectomy after noncurative ESD.
Tertiary care center.
Eight of 333 patients receiving ESD at Oita University Faculty of Medicine from 1999 to 2008 underwent additional laparoscopic gastrectomy because of noncurative ESD.
Intra-abdominal adhesions were evaluated by using an adhesion scoring system (0-3 points) and clinicopathologic findings, including artificial ulcerations after ESD.
All patients successfully underwent laparoscopic gastrectomy within 1 to 2 months after ESD. Three patients with large artificial ulceration (>25 mm) after ESD treatment had severe intra-abdominal adhesions (adhesion score > or =2). These patients tended to have a large blood loss and long operation times during laparoscopic gastrectomy. Despite the 2-month interval from ESD to laparoscopic gastrectomy, ulcerations in these patients were at healing stage with inflammatory cells infiltrating the muscular deep layer.
A retrospective study.
After ESD with large artificial ulceration (>25 mm), the presence of intra-abdominal adhesions complicating additional laparoscopic gastrectomy was often observed.
随着内镜黏膜下剥离术（ESD）治疗早期胃癌（EGC）的应用增加，越来越多的患者在非治愈性 ESD 后需要额外的胃切除术和淋巴结清扫。ESD 可能导致腹腔内粘连，使额外的腹腔镜胃切除术在技术上变得困难。
评估腹腔内粘连的存在与 ESD 治疗的关系，以确保安全的腹腔镜胃切除术。
回顾性分析非治愈性 ESD 后行额外腹腔镜胃切除术的病例系列研究。
三级医疗中心。
1999 年至 2008 年，大分大学医学部对 333 例接受 ESD 的患者中的 8 例因非治愈性 ESD 而行额外的腹腔镜胃切除术。
采用粘连评分系统（0-3 分）和临床病理发现评估腹腔内粘连，包括 ESD 后人工溃疡。
所有患者均在 ESD 后 1 至 2 个月内成功接受腹腔镜胃切除术。3 例 ESD 治疗后出现大的人工溃疡（>25mm）的患者有严重的腹腔内粘连（粘连评分>或=2）。这些患者在腹腔镜胃切除术中往往有大量出血和较长的手术时间。尽管 ESD 与腹腔镜胃切除术之间有 2 个月的间隔，但这些患者的溃疡处于愈合期，炎症细胞浸润到肌肉深层。
回顾性研究。
在 ESD 后出现大的人工溃疡（>25mm）时，常观察到腹腔内粘连的存在，这会使额外的腹腔镜胃切除术复杂化。
