Okuzono Toru, Kanno Yoshihide, Nakahori Masato, Aoki Hayato, Sato Shun, Matsuda Tomoki, Chonan Akimichi
Department of Gastroenterology, Sendai Kosei Hospital, Sendai, Japan.
Department of Gastroenterology, Sendai City Center, Sendai, Japan.
Dig Endosc. 2016 Nov;28(7):744-748. doi: 10.1111/den.12675. Epub 2016 Jul 18.
Recent studies have reported the usefulness of preoperative endoscopic ultrasonography-guided fiducial tattooing (EUS-tattooing) of the pancreas. However, problems of proper procedure, including markers and amounts, have not been resolved. The aim of the present study was to evaluate the feasibility of EUS-tattooing with a minuscule amount of marking solution using a new injector.
Six consecutive patients who underwent EUS-tattooing between June 2013 and April 2015 at our center were retrospectively analyzed (mean age, 60.7 years; males, 4). A 25-gauge needle was inserted into the surface of the pancreas near the tumor with EUS guidance. Then, 0.02 mL marking solution was injected three to five times (maximal total amount was defined as 0.1 mL). The marking solution used in this study was a compound of aqueous solution of sodium hyaluronate and India ink with proportions of 4 to 1. The newly developed injector for precise injection of minuscule amount of solution was used.
All six patients were successfully injected with the intended amount of marking solution. The tattoo mark was easily detected during surgery and localized in a small area in five patients. In one patient, however, the tattoo mark was not detected during surgery. There were no adverse events, including bleeding, perforation, and acute pancreatitis, by EUS-tattooing.
EUS-tattooing with a minuscule amount of marking solution using the newly developed injector was feasible and seemed useful and relatively safe. Further studies are warranted to confirm the safety and efficacy of EUS-tattooing.
近期研究报道了术前内镜超声引导下胰腺 fiducial 纹身术（EUS 纹身术）的有效性。然而，包括标记物和用量在内的合适操作问题尚未得到解决。本研究的目的是评估使用新型注射器注入极少量标记溶液进行 EUS 纹身术的可行性。
回顾性分析了 2013 年 6 月至 2015 年 4 月在本中心接受 EUS 纹身术的 6 例连续患者（平均年龄 60.7 岁；男性 4 例）。在 EUS 引导下，将一根 25 号针插入肿瘤附近的胰腺表面。然后，注入 0.02 mL 标记溶液，注射三至五次（最大总量定义为 0.1 mL）。本研究中使用的标记溶液是透明质酸钠水溶液和印度墨水按 4:1 比例混合的化合物。使用了新开发的用于精确注射极少量溶液的注射器。
所有 6 例患者均成功注入了预期量的标记溶液。手术过程中纹身标记易于检测到，5 例患者的纹身标记位于小区域内。然而，1 例患者在手术过程中未检测到纹身标记。EUS 纹身术未发生包括出血、穿孔和急性胰腺炎在内的不良事件。
使用新开发的注射器注入极少量标记溶液进行 EUS 纹身术是可行的，似乎有用且相对安全。有必要进行进一步研究以证实 EUS 纹身术的安全性和有效性。
