Kawachi Jun, Kashiwagi Hiroyuki, Ogino Hidemitsu, Isogai Naoko, Shimoyama Rai, Fukai Ryuta, Miyake Katsunori, Sasaki Akiko, Terashima Takahiro, Teshima Shinichi, Watanabe Kazunao
Department of Surgery, Shonan Kamakura General Hospital, Kamakura, Japan.
Gastroenterology Center, Shonan Kamakura General Hospital, Kamakura, Japan.
J Minim Access Surg. 2018 Jul-Sep;14(3):236-240. doi: 10.4103/jmas.JMAS_61_17.
In Japan, laparoscopic distal gastrectomy (LDG) is common for early gastric cancer. Formerly, we used to verify the location of the marking clip to decide the proximal incisional line with our hand, through a small epigastric incision. In 2015, we introduced intracorporeal reconstruction and started to decide the incisional line using intraoperative fluoroscopy. Herein, we aimed to evaluate the efficacy and safety of intraoperative fluoroscopy in LDG.
: A total of 19 patients were included in this retrospective observational study. On the day before operation, we endoscopically clipped several points located 2 cm proximal to the tumour edge to cover about half of the tumour. After lymph node dissection, we incised the stomach with an endoscopic linear stapling device, including the previously placed clips, guided by intraoperative fluoroscopy. Reconstruction was performed in all patients who underwent Billroth I and Roux-en-Y procedures.
No complications were observed during pre-operative endoscopic clipping or intraoperatively. On pathological examination, all resected specimens had negative margins, and the mean distance from the tumour edge was 28.5 ± 16.5 (13-60) mm.
Stomach resection with intraoperative fluoroscopic guidance was safe and effective.
在日本，腹腔镜远端胃切除术（LDG）常用于早期胃癌。以前，我们常常通过上腹部小切口，用手触摸来确定标记夹的位置，以决定近端切口线。2015年，我们引入了体内重建技术，并开始使用术中透视来确定切口线。在此，我们旨在评估术中透视在LDG中的有效性和安全性。
本回顾性观察研究共纳入19例患者。术前一天，我们在内镜下在肿瘤边缘近端2 cm处夹闭几个点，以覆盖约一半的肿瘤。淋巴结清扫后，在术中透视引导下，我们用内镜直线切割缝合器切开胃，包括先前放置的夹子。所有接受毕Ⅰ式和 Roux-en-Y 手术的患者均进行了重建。
术前内镜夹闭或术中均未观察到并发症。病理检查显示，所有切除标本切缘均为阴性，距肿瘤边缘的平均距离为28.5±16.5（13 - 60）mm。
术中透视引导下的胃切除术安全有效。
