Inoue Haruhiro, Ikeda Haruo, Onimaru Manabu, Sato Chiaki, Odaka Noriko, Itoh Hiroaki, Kudo Shin-Ei
Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan.
Nihon Geka Gakkai Zasshi. 2013 Nov;114(6):321-6.
Recently, endoscopic submucosal dissection (ESD) has been widely accepted as a curative, less-invasive treatment for early-stage gastric cancer. Laparoscopic gastrectomy is generally indicated in cases in which ESD could not be completed. When severe scar formation occurs in intramucosal cancer, it is often difficult to complete ESD and laparoscopic surgery must be performed. However, laparoscopic gastrecctomy for intramucosal cancer with deep ulcer scars may be overtreatment. Therefore, we developed a combined endoscopic and laparoscopic technique to perform full-thickness resection of the gastric wall. Laparoscopic and endoscopic cooperative surgery (LECS) has recently been highlighted by Hiki et al. LECS has been performed in various clinical situations, and the lesion-lifting method reported by Ohgami et al. is a beneficial application of the LECS technique. CLEAN-NET is a combination of laparoscopic and endoscopic approaches to neoplasia with a nonexposure technique. CLEAN-NET allows us to perform full-thickness gastric wall resection without any leakage of gastric contents into the abdominal cavity. We have so far performed CLEAN-NET in 39 consecutive patients. The results were clinically satisfactory, indicating that CLEAN-NET may have the potential to become a standard treatment option for T1N0 gastric cancer.
近年来，内镜黏膜下剥离术（ESD）已被广泛认可为早期胃癌的一种治愈性、微创治疗方法。腹腔镜胃切除术通常适用于无法完成ESD的病例。当黏膜内癌发生严重瘢痕形成时，往往难以完成ESD，必须进行腹腔镜手术。然而，对于伴有深部溃疡瘢痕的黏膜内癌进行腹腔镜胃切除术可能属于过度治疗。因此，我们开发了一种内镜与腹腔镜联合技术来进行胃壁全层切除。腹腔镜与内镜协作手术（LECS）最近受到了Hiki等人的关注。LECS已在各种临床情况下开展，Ohgami等人报道的病变提起法是LECS技术的一种有益应用。CLEAN-NET是一种腹腔镜与内镜相结合的肿瘤治疗方法，采用非暴露技术。CLEAN-NET使我们能够进行胃壁全层切除，而不会有任何胃内容物漏入腹腔。到目前为止，我们已连续对39例患者实施了CLEAN-NET。结果在临床上令人满意，表明CLEAN-NET可能有潜力成为T1N0胃癌的标准治疗选择。
