杂交自然腔道内镜手术：内镜全层切除术治疗早期胃癌和腹腔镜区域淋巴结清扫术——14 例人体病例。
Hybrid natural orifice transluminal endoscopic surgery: endoscopic full-thickness resection of early gastric cancer and laparoscopic regional lymph node dissection--14 human cases.
机构信息
NOTES Research Group, Soonchunhyang University Hospital, Seoul, Korea.
出版信息
Endoscopy. 2011 Feb;43(2):134-9. doi: 10.1055/s-0030-1255955. Epub 2010 Nov 24.
BACKGROUND AND STUDY AIM
Minimally invasive treatment has become a mainstay management strategy for early gastric cancer (EGC). Full-thickness incision of the gastric wall using natural orifice transluminal endoscopic surgery (NOTES) has been reported but is not easily applicable in clinical settings at present. The aim of the current study was to assess the feasibility of hybrid NOTES, which consists of endoscopic full-thickness gastric resection and a laparoscopic lymphadenectomy.
PATIENTS AND METHODS
This was a prospective, pilot study at a single tertiary care referral center. A total of 14 patients with EGC located above the lower third of the stomach underwent hybrid NOTES. Clinically, the patients had contraindications to exclusive treatment using endoscopic submucosal dissection (ESD). The main outcome measure was technical success of hybrid NOTES.
RESULTS
All cases were resected en bloc with negative surgical margins. Histologically, four cases were mucosal cancers, and 10 cases were submucosal cancers. The median tumor size was 26 mm (range 12 - 90 mm). Lymphatic vessel invasion was found in four cases without lymph node metastasis (LNM). The median number of obtained lymph nodes was 18 (range 7 - 67). LNM was discovered in one case of undifferentiated submucosal cancer without lymphovascular invasion. Hybrid NOTES was conducted without intraoperative or postoperative adverse events in nine cases. The median operating time and estimated blood loss of successful cases were 143 minutes (range 110 - 253 minutes) and 16 mL (range 5 - 30 mL), respectively. The median hospital stay was 6 days (range 4 - 10 days). Five cases were converted to a subtotal gastrectomy for various reasons.
CONCLUSIONS
Hybrid NOTES could be a bridge between endoscopic resection and laparoscopic surgery and may prevent extensive gastrectomy in patients with EGC.
背景与研究目的
微创治疗已成为早期胃癌（EGC）的主要治疗策略。经自然腔道内镜手术（NOTES）全层胃壁切开术已被报道，但目前在临床实践中不易应用。本研究旨在评估内镜全层胃切除术和腹腔镜淋巴结清扫术相结合的杂交NOTES 的可行性。
患者和方法
这是在一家三级转诊中心进行的前瞻性、试点研究。共有 14 例位于胃下部三分之一以上的 EGC 患者接受了杂交 NOTES。临床上，这些患者有内镜黏膜下剥离术（ESD）的绝对禁忌症。主要观察指标为杂交 NOTES 的技术成功率。
结果
所有病例均整块切除且切缘阴性。组织学上，4 例为黏膜癌，10 例为黏膜下癌。肿瘤中位大小为 26mm（范围 12-90mm）。4 例无淋巴结转移（LNM）的病例发现淋巴管侵犯。获得的淋巴结中位数为 18 个（范围 7-67 个）。1 例无血管淋巴管侵犯的未分化黏膜下癌发现 LNM。9 例无术中或术后不良事件成功实施了杂交 NOTES。成功病例的中位手术时间和估计出血量分别为 143 分钟（范围 110-253 分钟）和 16 毫升（范围 5-30 毫升）。中位住院时间为 6 天（范围 4-10 天）。5 例因各种原因转为胃大部切除术。
结论
杂交 NOTES 可能是内镜切除和腹腔镜手术之间的桥梁，可以防止 EGC 患者进行广泛的胃切除术。
Zotero 插件