Kamada Teppei, Yoshida Masashi, Ohdaira Hironori, Hoshimoto Sojun, Narihiro Satoshi, Suzuki Norihiko, Marukuchi Rui, Takeuchi Hideyuki, Suzuki Yutaka
Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara, Tochigi, 329-2763, Japan.
Int J Surg Case Rep. 2020;69:5-9. doi: 10.1016/j.ijscr.2020.03.008. Epub 2020 Mar 9.
Photodynamic diagnosis (PDD) using 5-aminolevulinic acid (5-ALA) has been used as a diagnostic procedure for malignant diseases. Dedicated laparoscopes (e.g., an IMAGE1 Camera System®) are used for this procedure. We report a case treated with laparoscopic total gastrectomy with 5-ALA-PDD using the PINPOINT® system.
A patient in his 80 s with diffuse-type gastric cancer with pyloric stenosis and ascites was admitted to our hospital. Double percutaneous transesophageal gastrotubing (dPTEG) for both gastric decompression and enteral nutrition and two cycles of preoperative chemotherapy with S-1 plus oxaliplatin were performed preoperatively. Additionally, we preoperatively performed an ex vivo experiment that confirmed that the PINPOINT® system can be used to observed protoporphyrin IX (PpIX) fluorescence. Three hours before surgery, 5-ALA hydrochloride was administered through dPTEG. Observation was performed by PINPOINT®, and Aladuck® was used as an excitation light source. Peritoneal nodules and sampled lymph nodes with red fluorescence were observed by 5-ALA-PDD. Accordingly, we gave up a radical operation and laparoscopic total gastrectomy without systematic lymphadenectomy to improve anemia and release pyloric stenosis was performed. The patient's postoperative course was uneventful.
It is possible that the connection with each of the scopes and an exclusive light source (Aladuck®) enable the easy use of 5-ALA-PDD without dedicated laparoscopy. It is expected that 5-ALA-PDD would show the further spread of gastrointestinal cancer if it could be performed with many types of laparoscopes.
We found that 5-ALA-PDD-guided surgery can be easily performed in a short time using the PINPOINT® system.
使用5-氨基酮戊酸（5-ALA）的光动力诊断（PDD）已被用作恶性疾病的诊断方法。该操作使用专用腹腔镜（如IMAGE1摄像系统®）。我们报告了一例使用PINPOINT®系统进行5-ALA-PDD腹腔镜全胃切除术的病例。
一名80多岁患有弥漫型胃癌伴幽门狭窄和腹水的患者入住我院。术前进行了双经皮经食管胃造瘘术（dPTEG）以进行胃减压和肠内营养，并进行了两个周期的S-1联合奥沙利铂术前化疗。此外，我们术前进行了一项体外实验，证实PINPOINT®系统可用于观察原卟啉IX（PpIX）荧光。手术前3小时，通过dPTEG给予盐酸5-ALA。使用PINPOINT®进行观察，并使用Aladuck®作为激发光源。通过5-ALA-PDD观察到有红色荧光的腹膜结节和取样淋巴结。因此，我们放弃了根治性手术，未进行系统淋巴结清扫的腹腔镜全胃切除术，转而进行改善贫血和解除幽门狭窄的手术。患者术后恢复顺利。
每个内窥镜与专用光源（Aladuck®）的连接使得在无需专用腹腔镜的情况下也能轻松使用5-ALA-PDD。如果5-ALA-PDD能够与多种类型的腹腔镜配合使用，预计它将显示出胃肠道癌的进一步扩散情况。
我们发现使用PINPOINT®系统可以在短时间内轻松进行5-ALA-PDD引导下的手术。
