Tokuhara Takaya, Nakata Eiji, Tenjo Toshiyuki, Kawai Isao, Satoi Syunpei, Inoue Keisuke, Araki Mariko, Ueda Hirofumi, Higashi Chihiro
Department of Surgery, Otori Stomach and Intestines Hospital, Sakai, Osaka 593-8311, Japan.
Mol Clin Oncol. 2017 Apr;6(4):483-486. doi: 10.3892/mco.2017.1191. Epub 2017 Mar 9.
In totally laparoscopic distal gastrectomy (TLDG) for gastric cancer, accurately determining the proximal resection line may be difficult. This is because identifying the lesion intracorporeally is impossible, due to the lack of tactile sense, and, in addition, unlike the intestine, the most proximal site of the lesion is often different from the main site due to the distorted shape of the stomach. The aim of this study was to introduce a novel method of preoperative endoscopic marking with India ink, taking into consideration the morphological characteristics of the stomach. Between July, 2013 and April, 2016, 20 patients who underwent TLDG were enrolled in this study. Within the 3 days preceding the operation, after identifying the most proximal site of the lesion on the overlooking image of an endoscope, India ink was injected into the spot on the oral side of this site. The stomach was transected along the proximal border of the marked area. In all cases, the marked sites were localized and clearly identified during the operation, and the proximal resection margins were found to be negative on postoperative pathological examination. The mean length of the proximal margin was 46.0±14.0 mm. In conclusion, this preoperative endoscopic marking method may be useful in TLDG for gastric cancer.
在胃癌的全腹腔镜远端胃切除术（TLDG）中，准确确定近端切除线可能存在困难。这是因为由于缺乏触觉，在体内识别病变是不可能的，此外，与肠道不同，由于胃的形状扭曲，病变的最近端部位通常与主要部位不同。本研究的目的是考虑到胃的形态特征，引入一种用印度墨水进行术前内镜标记的新方法。2013年7月至2016年4月，20例行TLDG的患者纳入本研究。在手术前3天内，在内窥镜俯瞰图像上确定病变的最近端部位后，将印度墨水注入该部位口侧的点。沿着标记区域的近端边界切断胃。在所有病例中，标记部位在手术中均被定位并清晰识别，术后病理检查发现近端切缘阴性。近端切缘的平均长度为46.0±14.0mm。总之，这种术前内镜标记方法可能对胃癌的TLDG有用。
