Park Dae Hwa, Moon Hee Seok, Sul Ji Young, Kwon In Sun, Yun Gee Young, Lee Seo Hee, Park Jae Ho, Kim Ju Seok, Kang Sun Hyung, Lee Eaum Seok, Kim Seok Hyun, Sung Jae Kyu, Lee Byung Seok, Jeong Hyun Yong
Division of Gastroenterology, Department of Internal Medicine, Daejeon Veterans Hospital.
Division of Gastroenterology, Department of Internal Medicine.
Medicine (Baltimore). 2018 Nov;97(45):e13165. doi: 10.1097/MD.0000000000013165.
In this study, we evaluate the usefulness of preoperative endoscopic clipping for early gastric cancer (EGC) localization in laparoscopic distal gastrectomy.We retrospectively screened all consecutive patients who underwent laparoscopic distal gastrectomy for EGC by 1 surgeon at Chungnam National University Hospital between January 2014 and December 2016. Patients who underwent combined surgery and patients who had tumors at the lower third of the stomach were excluded. Endoscopic clipping was performed prior to surgery by specialized endoscopists. During the operation, endoscopic metal clips were found using surgical devices, and laparoscopic vessel clips were attached on the presumed site; thereafter, intraoperative radiographs were obtained for confirmation.We analyzed a total of 196 patients; of them, 101 were classified into the clipping group (CG) and 95 into the non clipping group (NCG). The 2 groups were comparable regarding their demographic characteristics. The CG showed less additional resection (2 of 101 patients [2.0%] vs 9 of 95 patients [9.4%], P = .021) and better outcomes in terms of the operation time (P = .000), duration of hospital stay (P = .036), and postoperative atelectasis (P = .001) than the NCG.Preoperative endoscopic clipping was helpful in determining the exact resection margin in laparoscopic distal gastrectomy for EGC.
在本研究中，我们评估了术前内镜下夹闭术在腹腔镜远端胃癌根治术中对早期胃癌（EGC）定位的有效性。我们回顾性筛选了2014年1月至2016年12月期间在忠南国立大学医院由1名外科医生为EGC患者实施腹腔镜远端胃癌根治术的所有连续病例。接受联合手术的患者以及胃下三分之一处有肿瘤的患者被排除。术前由专业内镜医师进行内镜下夹闭术。手术过程中，使用手术器械寻找内镜金属夹，并在推测部位夹上腹腔镜血管夹；此后，获取术中X光片进行确认。我们共分析了196例患者；其中，101例被归入夹闭组（CG），95例被归入非夹闭组（NCG）。两组在人口统计学特征方面具有可比性。与非夹闭组相比，夹闭组的额外切除较少（101例患者中有2例[2.0%]，而95例患者中有9例[9.4%]，P = 0.021），并且在手术时间（P = 0.000）、住院时间（P = 0.036）和术后肺不张（P = 0.001）方面有更好的结果。术前内镜下夹闭术有助于在腹腔镜远端胃癌根治术中确定EGC的确切切除边缘。
