Department of Digestive Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki 701-0192, Japan.
Surg Endosc. 2013 Jul;27(7):2337-41. doi: 10.1007/s00464-012-2777-3. Epub 2013 Jan 24.
The small bowel has been considered the "black box" of gastroenterology. Identifying the exact site of small bowel hemorrhage is often difficult, thus complicating surgical treatment. We report two cases of small bowel bleeding lesions that were successfully managed by intraoperative real-time capsule endoscopy and minimally invasive surgery.
We developed a double-lumen tube similar to, but thinner and longer than, the Miller-Abbott tube. We insert the tube nasally, 3 or 4 days preoperatively, such that its balloon tip reaches the anus by the operative day. During surgery, the endoscopic capsule is connected to the balloon tip of the tube that protrudes from the anus. An assistant pulls on the nasal end of the tube, bringing the balloon tip and capsule back into the bowel. Capsule endoscopic images are displayed in a real-time video format.
We employed this procedure in two patients with repeated melena. Various examinations including gastroendoscopy and total colonoscopy showed bleeding confined to the small bowel, but the exact lesion site was unknown. Minimally invasive surgery was successfully performed in both patients: open minilaparotomy in one and laparoscopy in the other. The small bowel and capsule endoscope were easily controlled during minilaparotomy, and real-time capsule endoscopic images clearly identified the bleeding lesion. Control of the small bowel was more difficult in the laparoscopic case; however, real-time capsule endoscopic images identified a small tumor that was successfully resected.
Intraoperative capsule endoscopy combined with the tube provides surgeons real-time images indicating the exact site of lesions. The tube also helps surgeons control the position of the capsule endoscope and enables suction of intraluminal fluid or inflation of the lumen to allow clearer views during the operation. We conclude that combined use of capsule endoscopy and the tube facilitates management of bleeding lesions in the small bowel.
小肠一直被认为是消化内科的“黑箱”。准确识别小肠出血的部位通常很困难，从而使手术治疗变得复杂。我们报告两例通过术中实时胶囊内镜和微创手术成功治疗的小肠出血病变。
我们开发了一种类似于米勒-阿博特管的双腔管，但更细更长。我们将管经鼻插入，在术前 3 或 4 天，使其球囊尖端在手术日到达肛门。手术过程中，将胶囊内镜连接到从肛门伸出的管的球囊尖端。助手拉动管的鼻端，将球囊尖端和胶囊拉回肠内。胶囊内镜图像以实时视频格式显示。
我们对两名反复黑便的患者使用了该程序。包括胃肠镜和全结肠镜在内的各种检查均显示出血局限于小肠，但确切的病变部位未知。两名患者均成功进行了微创手术：一名采用开放小剖腹术，另一名采用腹腔镜手术。在小剖腹术中，小肠和胶囊内镜很容易控制，实时胶囊内镜图像清楚地识别了出血病变。在腹腔镜病例中，对小肠的控制更为困难；然而，实时胶囊内镜图像识别出一个小肿瘤，并成功切除。
术中胶囊内镜与管相结合为外科医生提供了指示病变确切部位的实时图像。该管还帮助外科医生控制胶囊内镜的位置，并允许在手术过程中抽吸管腔中的液体或膨胀管腔以获得更清晰的视野。我们得出结论，胶囊内镜和管的联合使用有助于处理小肠出血病变。
